What the Proportional Recovery Rule Is (and Is Not): Methodological and Statistical Considerations

Fuck proportional recovery and the failure it represents. Have you EVER talked to any stroke survivor that accepted proportional recovery without them being brain-washed into accepting your tyranny of low expectations? I would fire you on the spot for this crapola.  Research like this just solidifies the reasons you don't belong in stroke. 

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 
Politeness will never solve anything in stroke.  I call them as I see them. I would have them fired.

 WHEN THE HELL are you going to deliver 100% recovery? THAT is the ONLY GOAL IN STROKE!

What the Proportional Recovery Rule Is (and Is Not): Methodological and Statistical Considerations

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Robinson Kundert, MSc, Jeff Goldsmith, PhD*, Janne M. Veerbeek, PhD, ...

First Published September 15, 2019 Research Article

https://doi.org/10.1177/1545968319872996

Article information

Abstract

In 2008, it was proposed that the magnitude of recovery from nonsevere upper limb motor impairment over the first 3 to 6 months after stroke, measured with the Fugl-Meyer Assessment (FMA), is approximately 0.7 times the initial impairment (“proportional recovery”). In contrast to patients with nonsevere hemiparesis, about 30% of patients with an initial severe paresis do not show such recovery (“nonrecoverers”). Hence it was suggested that the proportional recovery rule (PRR) was a manifestation of a spontaneous mechanism that is present in all patients with mild-to-moderate paresis but only in some with severe paresis. Since the introduction of the PRR, it has subsequently been applied to other motor and nonmotor impairments. This more general investigation of the PRR has led to inconsistencies in its formulation and application, making it difficult to draw conclusions across studies and precipitating some cogent criticism. Here, we conduct a detailed comparison of the different studies reporting proportional recovery and, where appropriate, critique statistical methodology. On balance, we conclude that existing data in aggregate are largely consistent with the PRR as a population-level model for upper limb motor recovery; recent reports of its demise are exaggerated, as these excessively focus on the less conclusive issue of individual subject-level predictions. Moving forward, we suggest that methodological caution and new analytical approaches will be needed to confirm (or refute) a systematic character to spontaneous recovery from motor and other poststroke impairments, which can be captured by a mathematical rule either at the population or at the subject level.