Balance and gait after first minor ischemic stroke in people 70 years of age or younger: A prospective observational cohort study

Abstract

Background. Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients <70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group. Objective. The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients <70 years with minor ischemic stroke (National Institutes of Health Stroke Scale score <3). This study also explored factors predicting impaired balance after 12 months. Design. This study was designed as an explorative longitudinal cohort study. Methods. Patients were recruited consecutively from 2 stroke units. Balance and gait were assessed with the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, and preferred gait speed. Predictors for impaired balance were explored using logistic regression. Results. This study included 101 patients.Mean (SD) age was 55.5 (11.4) years, 20% were female, and mean (SD) National Institutes of Health Stroke Scale score was 0.6 (0.9) points. The Mini-BESTest, gait speed, and Timed Up and Go improved significantly from the acute phase to 3 months, and gait speed also improved from 3 to 12 months. At 12 months, 26% had balance impairments and 33% walked slower than 1.0 m/s. Poor balance in the acute phase (odds ratio = 0.92, 95% confidence interval = 0.85.0.95) was the only predictor of balance impairments (Mini-BESTest score ≤22) at 12 months poststroke. Limitations. Limitations include lack of information about pre-stroke balance and gait impairment and poststroke exercise. Few women limited the generalizability. Conclusion. This study observed improvements in both balance and gait during the follow-up; still, about one-third had balance or gait impairments at 12 months poststroke. Balance in the acute phase predicted impaired balance at 12 months.