The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization. In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization. For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R² = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11–14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R² = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82–2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission. Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability. An early assessment of walking function within days of stroke admission can help to streamline discharge planning. Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.

The Canadian Stroke Best Practice Recommendations 7 ^th edition update of the Rehabilitation, Recovery and Community Participation module is presented in three parts. This publication, Part One of the series, reflects the growing and changing body of research evidence available to guide planning, ongoing screening and assessment, management, education, and support of individuals with stroke, their families, and caregivers. This module provides guidance for the planning and delivery of coordinated and seamless systems of care from acute stroke onset to return to community settings by an interdisciplinary team of healthcare providers with expertise in stroke. These recommendations were developed with active involvement of people with lived experience of stroke at all phases. These recommendations are intended to support the progress achieved during the initial recovery stages and enable individuals with stroke to resume life roles and leisure activities as best as possible, to achieve optimal recovery goals. Evidence for effective rehabilitation therapies and support for individuals with stroke and their families continues to emerge and gaps in knowledge should drive future research.

The 7th edition update of the Rehabilitation, Recovery and Community Participation module is presented in three parts. Part Three of the series reflects the current research evidence focused on person-centered care, optimizing an individual’s return to their community and engaging in active and meaningful participation. Emphasis is placed on regular healthcare follow-up, maximizing secondary prevention strategies, assessment, diagnosis, and management of mood disorders and cognitive status, sleep health, and post-stroke fatigue. Personal issues that are important and meaningful to individuals with stroke are addressed, including returning to driving, vocational roles, relationships, sexuality, life roles, leisure, social participation, advance care planning, and palliative care. This module highlights the need for coordinated and seamless systems of care that extend beyond the first few months after stroke, building on progress achieved during the initial recovery, to support seamless longer-term recovery. The main goal of these recommendations is to help individuals with stroke achieve as much independence as possible in meaningful life roles and leisure activities. Successful planning across transitions requires integrated and coordinated people-centered efforts by all stroke team members and the broader community. Active engagement of the individual and family at all stages of planning and goal setting is essential.

In accelerometer-based measurement, inclusion of upper extremity (UE) activity during walking can overestimate real-world functional UE use in people post-stroke. This study introduces a comprehensive, accelerometer-based approach to examine real-world UE use, including contribution of UE activity during walking, and compares UE use during walking versus ADL-based activities. People with subacute stroke wore bilateral wrist and ankle inertial measurement units (IMU) for one week (24 hrs/day). Agreement between UE-Total, UE-Continuous Walking, and UE-ADL measures were assessed using Bland–Altman analyses. Variables were modeled using linear regression to explore step count, mobility aid use and UE motor impairment as predictors of IMU measures of real-world UE use. Agreement between UE-Total and UE-ADL measures showed minimal bias. Differences between UE-Continuous Walking and UE-ADL varied by mobility aid. UE-Continuous Walking was associated with increased UE activity and relatively greater paretic arm use compared with UE-ADL. Across UE-Continuous Walking and UE-ADL, step count was the strongest predictor of real-world UE use. UE activity during continuous walking exhibits different use patterns as compared to ADL-based activity. Accordingly, separating continuous walking-related UE activity from ADL-based UE use may improve clinical interpretation of IMU measures of real-world UE use in individuals with subacute stroke.

In accelerometer-based measurement, the inclusion of upper extremity (UE) activity during walking can overestimate real-world functional UE use in people post-stroke. This study introduces a comprehensive, accelerometer-based approach to examining real-world UE use, including the contribution of UE activity during walking, and compares UE use during walking versus ADL-based activities. People with subacute stroke wore bilateral wrist and ankle inertial measurement units (IMU) for one week (24 h/day). Agreement between UE-Total, UE-Continuous Walking and UE-ADL measures were assessed using Bland–Altman analyses. Variables were modeled using linear regression to explore step count, mobility aid use and UE motor impairment as predictors of IMU measures of real-world UE use. Agreement between UE-Total and UE-ADL measures showed minimal bias. Differences between UE-Continuous Walking and UE-ADL varied by mobility aid. UE-Continuous Walking was associated with increased UE activity and relatively greater paretic arm use compared with UE-ADL. Across UE-Continuous Walking and UE-ADL, step count was the strongest predictor of real-world UE use. UE activity during continuous walking exhibits different use patterns as compared to ADL-based activity. Accordingly, separating continuous walking-related UE activity from ADL-based UE use may improve clinical interpretation of IMU measures of real-world UE use in individuals with subacute stroke.