Independent Walking at Discharge in Nonsurgical Patients With Thalamic Hemorrhage Who Were Nonambulatory on Day 14: A Retrospective Study of Prognostic Factors

Background Thalamic hemorrhage may cause severe disability because it can affect motor, sensory, cognitive, and postural functions. However, it is often difficult to estimate later walking outcomes during early hospitalization, especially in patients who are still non-ambulatory 14 days after disease onset. Objective To identify the factors associated with independent walking at discharge in non-surgical patients with thalamic hemorrhage who were non-ambulatory on day 14. Methods We conducted a retrospective cohort study at a single stroke rehabilitation center and reviewed consecutive patients with acute thalamic hemorrhage admitted between April 2016 and March 2021. The initially eligible cohort comprised 101 patients. In this revised analysis, 19 patients who had already regained independent walking by day 14 were excluded, leaving 82 patients for the final analysis. The primary outcome was independent walking at discharge, defined as a Functional Independence Measure (FIM) walk item score of 6 or 7. Clinical variables were collected from the medical records, and a multivariable logistic regression analysis was performed. Results Of the 82 patients, 39 achieved independent walking at discharge. The independent walking group showed younger age, lower National Institutes of Health Stroke Scale scores at admission, and higher day-14 FIM motor scores than the non-independent walking group. The multivariable logistic regression model showed that younger age (odds ratio OR, 0.88; 95% confidence interval CI, 0.80-0.95; p = 0.0003) and a higher FIM motor score on day 14 (OR, 1.21; 95% CI, 1.12-1.33; p < 0.0001) were independently associated with walking independence at discharge. Conclusions In non-surgical patients with thalamic hemorrhage who were non-ambulatory on day 14, younger age and better motor function on day 14 were associated with independent walking at discharge. In our setting, a simple bedside functional assessment on day 14 may help estimate walking status at hospital discharge. However, these findings should be interpreted cautiously, as discharge walking status may also be influenced by rehabilitation practice and institutional factors.