Structural Modeling of Early Ambulation Progression in Patients with Acute Stroke: A Covariance Structure Analysis Approach.

Abstract

Objectives: This study used structural equation modeling (SEM) to elucidate the causal relationships between Functional Independence Measure (FIM) items and consciousness levels in patients with stroke and low consciousness levels 2 weeks after initiating occupational therapy (OT). This modeling sought to identify the factors influencing the number of days required to get out of bed.

Methods: SEM was used for multifactorial simultaneous analysis in a study of 22 patients with a Japan Coma Scale score of 20 after stroke. The Glasgow Coma Scale was used to evaluate patients' consciousness level; FIMs were used to evaluate activities of daily living in the ward. Influencing factors, including "bed/chair transfers" and "toilet transfers," were defined as "transfer functions," while factors involving "social interactions," "comprehension," "memory," "problem solving," and "expression" were defined as "cognitive decline."

Results: After 2 weeks, standardized coefficients showed that "transfer functions" and "cognitive decline" had effects of -0.33 and -0.25, respectively, on "early ambulation days." Further analysis revealed that improvements in "consciousness level" impacted "early ambulation days," with coefficients of -0.35 for "transfer functions" and 0.14 for "cognitive decline." Through the "consciousness level" observation variable, the coefficients of indirect effects were -0.27 for "transfer function" on "days to get out of bed," 0.38 for "cognitive decline," and -0.06 for "self-care" on "early ambulation days."

Conclusions: Improvement in transfer movements and cognitive decline influenced the number of days required to get out of bed without improving consciousness or affecting early ambulation.