An article in Stroke magazine made me angry. The authors said they could predict independent walking three months after a stroke based on early status after the stroke (1). These predictors included younger age, good leg strength, good sitting, continence, no cognitive impairment, no neglect, and independence in activities of daily living.
What made me angry is that the authors recommended these data be used to decide who should get rehab and who should go straight to residential care (1). Data that describe groups of people cannot accurately predict which group a specific individual will end up in. For example, data that says a chemotherapy treatment is 80% effective does not tell you if a client if will be in the 80% that will be cured or in the 20% that will die.
There is no such thing as a perfect prediction because unaccounted for variables can change an outcome. For example, years ago I went to the nursing floor and found two nurses transferring my client from a wheelchair to the bed. When I asked why I could transfer him with minimum assistance but he needed two nurses to do it he said "therapists make you do things for yourself and nurses do things for you". He did not show the least bit of embarassment when he said this. I wondered which rationale he applied to his wife.
To withhold care because of early status is *****! It it fairer and more accurate to make decisions based on the amount, speed, and consistency of improvement. homeafterstroke.blogspot.com
1. Preston E, Ada L, Stanton R, Mahendran N, Dean C. Prediction of independent walking in people who are nonambulatory early after stroke: A systematic review. Stroke. 2021 July. doi: 10.1161/STROKEAHA.120.03245.