Cognitive Function is a Predictor of the Daily Step Count in Patients With Subacute Stroke With Independent Walking Ability: A Prospective Cohort Study

OBJECTIVES: To investigate the physical, cognitive, and psychological factors related to daily step count in patients with subacute stroke. DESIGN: Prospective cohort study. SETTING: A subacute rehabilitation ward with 160 beds. PARTICIPANTS: Patients with subacute stroke who could walk independently (N=101). Among the 101 participants enrolled in this study (mean age, 64.5±13.5y), 64.4% (n=65) were men and 69.3% (n=70) were patients with cerebral infarction. INTERVENTIONS: We assessed ambulatory activity using a pedometer placed in the pants pocket on the nonparalyzed side continuously for 7 consecutive days. We also obtained demographic and clinical information and recorded the following measurement scores: Stroke Impairment Assessment Set, FIM, Mini-Mental State Examination (MMSE), Self-Rating Depression Scale, and Apathy Scale. All measurements were collected at admission and discharge. MAIN OUTCOME MEASURES: The outcomes assessed were ambulatory activity, motor and sensory functions, functional disability, cognitive function, depressive symptoms, and motivation. RESULTS: The median daily steps ambulated at admission and discharge were 5584 steps (interquartile range, 3763-7096 steps) and 5991 steps (interquartile range, 4329-8204 steps), respectively. In the univariate regression analysis, age, sex, serum albumin level, affected side of the brain, and MMSE score at admission were significantly associated with the daily step count at discharge. Multiple regression analysis using these 5 items as independent variables revealed that the MMSE score at admission (reference, 28-30 points; B, −2.07; 95% confidence interval, −3.89 to −0.35; β, −0.22; P=.027) was significantly associated with the daily step count at discharge. CONCLUSIONS: Cognitive function at admission had a significant association with the daily step count at discharge in patients with subacute stroke who could walk independently.