To determine the reliability, concurrent and predictive validity, and responsiveness
of the Functional Ambulation Category (FAC) in hemiparetic patients after stroke.
Prospective cohort.
An early rehabilitation center for patients with neurologic disorders.
Fifty-five nonambulatory patients after first-ever stroke, with duration of illness
between 30 and 60 days, were included.
Not applicable.
FAC, Rivermead Mobility Index (RMI), walking velocity, step length, and six-minute
walking test (6MWT) were assessed at the beginning, after 2 and 4 weeks of rehabilitation,
and again 6 months later. After 6 months, community ambulation was also assessed.
Test-retest and interrater reliability, concurrent, discriminant, and predictive validity
and responsiveness of the FAC were calculated.
Based on video examinations, high test-retest reliability (Cohen kappa=.950) and interrater
reliability (kappa=.905) were found. FAC scores at the beginning and after 2 weeks,
3 weeks, and 6 months correlated highly with the RMI (Spearman rho=.686, rho=.787,
rho=.825, rho=.893, respectively), distance walked in the 6MWT (rho=.949, rho=.937,
rho=.931, rho=.906, respectively), walking velocity (rho=.952, rho=.939, rho=.902,
rho=.901, respectively), and step length (rho=.952, rho=.932, rho=.896, rho=.877,
respectively) at the same time points (all P<.001). The RMI, walking velocity, step
length, and distance walked in the 6MWT differed for each FAC category (P<.001). After
4 weeks of rehabilitation, an FAC score of 4 or higher predicted community ambulation
at 6 months with 100% sensitivity and 78% specificity. FAC scores changed significantly
between the first 2 and second 2 weeks (Wilcoxon z=8.7, z=7.9, respectively; both
P<.001) of the inpatient rehabilitation program.
The FAC has excellent reliability, good concurrent and predictive validity, and good
responsiveness in patients with hemiparesis after stroke.