Predictors of Clinically Important Changes in Actual and Perceived Functional Arm Use of the Affected Upper Limb After Rehabilitative Therapy in Chronic Stroke

 

Why are you predicting outcome rather than delivering research that results in great functional outcome? I'd fire you all for missing the whole point of stroke research. SURVIVOR RECOVERY!

Even Ph.D.s are stupid in this regard!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHAT GOOD does knowing this get survivors recovered with NO EXCUSES! Your definition of competence in stroke is obviously much lower than stroke survivors' definition of your competence! Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.

Predictors of Clinically Important Changes in Actual and Perceived Functional Arm Use of the Affected Upper Limb After Rehabilitative Therapy in Chronic Stroke

Yi-chun Li, MS^a ∙ Wan-wen Liao, PhD^a ∙ Yu-wei Hsieh, PhD^b,c,d ∙ Keh-chung Lin, ScD, OTR^a,e kehchunglin@ntu.edu.tw ∙ Chia-ling Chen, PhD, MD^d,f

Cite

• Set Alert
• Get Rights
• Reprints

• Previous articleNext article

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.