Easily Conducted Tests During the First Week Post-stroke Can Aid the Prediction of Arm Functioning at 6 Months

Survivors don't give a shit about predictions, they want REHAB RESULTS.  Go back and do your job properly.  If you didn't know it, your one and only stroke job is to get survivors 100% recovered.  Maybe you need to train your mentors and senior researchers in that also. It is called leading upwards, try it sometime. This failure is assuming the status quo will not change. CHANGE THE STATUS QUO! When you are the 1 in 4 per WHO that has a stroke you will be glad you actually solved stroke instead of coasting in your job. 

Easily Conducted Tests During  the First Week Post-stroke Can Aid the Prediction of Arm Functioning at 6 Months

Emma Ghaziani^1*, Christian Couppé^1,2,3, Volkert Siersma⁴, Hanne Christensen^5,6, S. Peter Magnusson^1,2,3, Katharina S. Sunnerhagen⁷, Hanna C. Persson⁷ and Margit Alt Murphy⁷

• ¹Department of Physical and Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark
• ²Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
• ³Faculty of Health and Medical Sciences, Centre for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
• ⁴Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
• ⁵Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
• ⁶Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
• ⁷Research Unit for Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden

Background: 

Prognostic models can estimate the recovery of arm functioning after stroke, guide the selection of individual training strategies, and inform patient selection in clinical trials. Several models for early prediction of arm recovery have been proposed, but their implementation has been hindered by insufficient external validation, limited evidence of their impact on patient outcomes, and reliance on predictors that are not feasible in regular clinical practice.

Objectives: 

To determine the predictive value of new and previously reported tests that can be easily conducted in regular clinical settings for early prognosis of two levels of favorable arm recovery at 6 months post-stroke.

Methods: 

We performed a secondary analysis of merged data (n = 223) from two Scandinavian prospective longitudinal cohorts. The candidate predictors were seven individual tests of motor function and the sensory function measured by the Fugl-Meyer Assessment of Upper Extremity within 7 days post-stroke, and the whole motor section of this assessment. For each candidate predictor, we calculated the adjusted odds ratio (OR) of two levels of residual motor impairment in the affected arm at 6 months post-stroke: moderate-to-mild (≥32 points on the motor section of the Fugl-Meyer Assessment of Upper Extremity, FMA-UE) and mild (FMA-UE ≥ 58 points).

Results: 

Patients with partial shoulder abduction (OR 14.6), elbow extension (OR 15.9), and finger extension (OR 9.5) were more likely to reach FMA-UE ≥ 32. Patients with full function on all individual motor tests (OR 5.5–35.3) or partial elbow extension, pronation/supination, wrist dorsiflexion and grasping ability (OR 2.1–18.3) were more likely to achieve FMA-UE ≥ 58 compared with those with absent function. Intact sensory function (OR 2.0–2.2) and moderate motor impairment on the FMA-UE (OR 7.5) were also associated with favorable outcome.

Conclusions: 

Easily conducted motor tests can be useful for early prediction of arm recovery. The added value of this study is the prediction of two levels of a favorable functional outcome from simple motor tests. This knowledge can be used in the development of prognostic models feasible in regular clinical settings, inform patient selection and stratification in future trials, and guide clinicians in the selection of individualized training strategies for improving arm functioning after stroke.

Clinical Trial Registration: ClinicalTrials.gov: NCT02250365, NCT01115348.