Interaction between Locomotion and Self-Care for Patients with Stroke in Severity Classification Based on the Motor Functional Independence Measure upon Admission to the Recovery Ward

Background: A correlation between self-care and gait in stroke patients has been shown. However, there are few reports suggesting an interaction between self-care and gait. Purpose: To investigate the interaction between locomotion and improvements in self-care. Participants and Methods: We retrospectively analyzed 3034 stroke patients who were registered in the Japanese Rehabilitation Database. Using their data, patients were classified into three groups (severe, moderate, slight) based on the motor functional independence measure upon admission, and data were modified as mean-centered values. We performed a correlation analysis to evaluate the relationship among all the collected data. Subsequently, a hierarchical multiple regression analysis was performed to evaluate interaction using the self-care motor score from the Functional Independent Measure (FIM) as the dependent variable. Model 1 used two independent variables (National Institutes of Health Stroke Scale and cognitive FIM score), model 2 used two independent variables (locomotion gain and gain of an item with the strongest correlation coefficient to the de-pendent variable), and model 3 used a mean-centering value, which was added to model 2. The simple slope was used for further analysis. Results: Locomotion showed an interaction with self-care, except in the slight group. The R2 changes in models 1 and 2 were significant in the following: grooming, dressing lower body, and bladder management in the severe group (p < 0.01), and only dressing upper body in the moderate group (p < 0.01). Results of the simple slope analysis were significant for grooming, bowel management, and dressing lower body in the severe group and for dressing upper body in the moderate group. Conclusion: Locomotion demonstrated interaction with improving self-care, mainly in the severe group. Therefore, for moderate and slight cases, an intervention that not only involves locomotion training but also focuses on improving activities of daily living should be considered.