Time-course for acquiring transfer independence in patients with subacute stroke: a prospective cohort study.

Objective: To clarify the time-course of longitudinal changes in the independence level of subtasks composing bed-wheelchair transfer among patients with stroke.

Design: Single-institution prospective cohort study.

Patients: A total of 137 consecutive post-stroke patients using wheelchair on admission to the subacute rehabilitation wards.

Methods: The independence degree in each of the 25 transfer-related subtasks was assessed using the Bed-Wheelchair Transfer Tasks Assessment Form on a three-level scale every two weeks, from admission to the endpoint (either discharge or when achieving independent transfer). Patients were classified based on admission and endpoint assessment form scores using two-step cluster analysis.

Results: Patients were classified into three clusters. The first cluster included 50 patients who exhibited a greater independence level in all subtasks on admission (52.0-100% of patients performed each subtask independently) and at the endpoint (64.0-100%). The second included 30 patients who showed less independence on admission (0-27.8%) but achieved greater independence levels at the endpoint (44.4-97.2%). The third included 51 patients whose independence level remained low in many subtasks from admission (0-5.8%) until the endpoint (0-29.4%).

Conclusion: The independence level and its changing process during transfer were categorized into three time-courses, each requiring different intervention strategies.