This precluded consideration of other candidate predictors, especially in the upper limb prediction

models. A second limitation to consider is the timing of our baseline measurements. We collected baseline measurements of predictors within the first four weeks of stroke as it was difficult to recruit participants and carry out measurements quickly in an acute stroke cohort where patients were very unwell. Measurement of predictors should DNA Damage inhibitor be made early in the first few days after stroke if prediction models are to be used early to guide clinicians’ decision-making in goal setting, therapy selection, and discharge planning (Nijland et al 2010, Veerbeek et al 2011). Even though our baseline measurements were taken at a median of 6 days (IQR 3 to 11) after stroke, the models may have had more clinical utility if all measurements had been obtained within this timeframe or if all measurements had been obtained earlier than 6 days. Third, our prediction models only allow the prediction of recovery in ambulation and upper limb function six months after stroke. Functional recovery has been reported to extend beyond six months (Kollen et al 2005).

It is possible that patients who were predicted not to recover independent ambulation or functional use of their arms recovered after six months. Future studies could follow patients over a longer time period to capture a more accurate picture of recovery in ambulation and upper limb function. Lastly, despite its broad inclusion criteria, the cohort was recruited from only one hospital in Australia. This hospital Rebamipide may not be representative NVP-BKM120 nmr of all hospitals across Australia because it only admits patients from its surrounding geographical area and it may provide slightly different care to other hospitals. External

validation of our prediction models in cohorts from other hospitals is required before the prediction models can be used in clinical practice (Konig et al 2007). More than two-thirds of those who are initially nonambulant recover independent ambulation, but less than half of those who initially lack upper limb function recover functional use of their upper limbs six months after stroke. Prediction models using age and NIHSS can predict independent ambulation and upper limb function six months after stroke, although these models require external validation. Ethics: The local Human Research Ethics Committee (South Eastern Sydney and Illawarra Area Health Service) approved the study. All participants or guardians gave written informed consent before data collection began. Competing interests: None Support: Partly supported by the APA Physiotherapy Research Foundation and by the Neurology Department of St George Hospital. Rob Herbert is supported by the Australian NHMRC. The authors thank patients and family members who were part of the study. The authors also thank Li Na Goh and Min Jiat Teng who worked as research assistants on the project.