Predictors of Clinically Important Changes in Actual and Perceived Functional Arm Use of the Affected Upper Limb After Rehabilitative Therapy in Chronic Stroke
Journal
Archives of physical medicine and rehabilitation
Journal Volume
101
Journal Issue
3
Date Issued
2020-03
Author(s)
Abstract
OBJECTIVE:
To identify the predictors of minimal clinically important changes in actual and perceived functional arm use of the affected upper limb after rehabilitative therapy.
DESIGN:
Retrospective, observational cohort study.
SETTING:
Outpatient rehabilitation settings.
PARTICIPANTS:
A cohort of 94 patients with chronic stroke.
INTERVENTIONS:
Patients received robot-assisted therapy, mirror therapy, or combined therapy for 4 weeks.
MAIN OUTCOME MEASURES:
The primary outcome measures, assessed pre- and post intervention, included actual functional arm use measured by an accelerometer and perceived functional arm use measured by the Motor Activity Log (MAL). Candidate predictors included age, sex, time after stroke, side of stroke, and scores on the Fugl-Meyer Assessment, Modified Ashworth Scale, Medical Research Council scale, Wolf Motor Function Test, MAL (quality of movement), and Nottingham Extended Activities of Daily Living.
RESULTS:
Being male (odds ratio [OR], 3.17; 95% CI, 1.13-8.87) and having a higher than median Medical Research Council score (OR, 2.68; 95% CI, 1.12-6.41) significantly predicted minimal clinically important changes assessed by an accelerometer. Fugl-Meyer Assessment scores (odds ratio, 1.06; 95% CI, 1.02-1.11) were a significant predictor of achieving clinically important changes in MAL amount of use. Wolf Motor Function Test (quality) scores (OR, 3.05; 95% CI, 1.38-6.77) could predict clinically important improvements in MAL quality of movement.
CONCLUSIONS:
Predictors of clinically important changes in the use of the affected upper limb after robot-assisted therapy, mirror therapy, or combined therapy in patients with chronic stroke for 4 weeks differ for actual vs perceived use. Further studies are recommended to validate these findings in a larger sample.
To identify the predictors of minimal clinically important changes in actual and perceived functional arm use of the affected upper limb after rehabilitative therapy.
DESIGN:
Retrospective, observational cohort study.
SETTING:
Outpatient rehabilitation settings.
PARTICIPANTS:
A cohort of 94 patients with chronic stroke.
INTERVENTIONS:
Patients received robot-assisted therapy, mirror therapy, or combined therapy for 4 weeks.
MAIN OUTCOME MEASURES:
The primary outcome measures, assessed pre- and post intervention, included actual functional arm use measured by an accelerometer and perceived functional arm use measured by the Motor Activity Log (MAL). Candidate predictors included age, sex, time after stroke, side of stroke, and scores on the Fugl-Meyer Assessment, Modified Ashworth Scale, Medical Research Council scale, Wolf Motor Function Test, MAL (quality of movement), and Nottingham Extended Activities of Daily Living.
RESULTS:
Being male (odds ratio [OR], 3.17; 95% CI, 1.13-8.87) and having a higher than median Medical Research Council score (OR, 2.68; 95% CI, 1.12-6.41) significantly predicted minimal clinically important changes assessed by an accelerometer. Fugl-Meyer Assessment scores (odds ratio, 1.06; 95% CI, 1.02-1.11) were a significant predictor of achieving clinically important changes in MAL amount of use. Wolf Motor Function Test (quality) scores (OR, 3.05; 95% CI, 1.38-6.77) could predict clinically important improvements in MAL quality of movement.
CONCLUSIONS:
Predictors of clinically important changes in the use of the affected upper limb after robot-assisted therapy, mirror therapy, or combined therapy in patients with chronic stroke for 4 weeks differ for actual vs perceived use. Further studies are recommended to validate these findings in a larger sample.
Subjects
Minimal clinically important difference; Prognosis; Rehabilitation; Stroke
SDGs
Other Subjects
accelerometry; adult; arm movement; Article; cerebrovascular accident; cohort analysis; female; fugl meyer assessment; functional assessment; human; major clinical study; male; medical research council scale; middle aged; minimal clinically important difference; modified ashworth scale; motor activity; motor function test; National Institutes of Health Stroke Scale; neurorehabilitation; Nottingham extended activities of daily living scale; observational study; outpatient department; predictive value; rating scale; retrospective study; robotics; secondary analysis; wolf motor function test; convalescence; daily life activity; minimal clinically important difference; pathophysiology; procedures; quality of life; questionnaire; risk factor; stroke rehabilitation; upper limb; Accelerometry; Activities of Daily Living; Female; Humans; Male; Middle Aged; Minimal Clinically Important Difference; Quality of Life; Recovery of Function; Retrospective Studies; Risk Factors; Stroke Rehabilitation; Surveys and Questionnaires; Upper Extremity
Type
journal article