The Predictive Role of Hand Section of Fugl–Meyer Assessment and Motor Activity Log in Action Research Arm Test in People With Stroke

 

Measurements and assessments NEVER GET ANYONE RECOVERED! I'd have you all fired for incompetency in not solving stroke!

The Predictive Role of Hand Section of Fugl–Meyer Assessment and Motor Activity Log in Action Research Arm Test in People With Stroke

Peiming Chen¹Tai-Wa Liu²Mimi M. Y. Tse^2,3Claudia K. Y. Lai^3,4Joshua Tsoh⁵Shamay S. M. Ng^1*

• ¹Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
• ²School of Nursing & Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong SAR, China
• ³School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
• ⁴School of Health Sciences, Yamaguchi University, Yamaguchi, Japan
• ⁵Department of Psychiatry, Prince of Wales Hospital & Shatin Hospital, Shatin, Hong Kong SAR, China

Background: Recent findings of clinical studies have demonstrated a significant positive relationship between Fugl–Meyer Assessment of upper extremity score and the action research arm test (ARAT) score in people with stroke. Although the motor activity log (MAL) can assess the self-perception of motor performance, which can affect the performance of the upper limb, the relationship between MAL score and ARAT score still remains unclear. The objective of this study is to quantify the independent contribution of MAL score and FMA-hand score on the ARAT score in people with stroke.

Methods: This is a cross-sectional study. There were a total of 87 subjects (50 males, 37 females; mean age = 61.12 ± 6.88 years, post-stroke duration=6.31 ± 2.84 years) included in this study. Self-perceived performance in using the paretic limb was measured by MAL, including subscale of the amount of usage (MAL-AOU) and quality of movement (MAL-QOM). Functional performance of the upper limb was measured by action research arm test (ARAT). Upper limb motor control of the hand was measured by hand section of Fugl–Meyer assessment (FMA-hand).

Results: The result showed that MAL-QOM (r = 0.648, p < 0.001), MAL-AOU (r = 0.606, p < 0.001), FMA-hand scores (r = 0.663, p < 0.001), and the use of a walking aid (r = −0.422, p < 0.001) were significantly correlated with the ARAT scores. A total 66.9% of the variance in the ARAT scores was predicted by the final regression model including MAL-QOM, MAL-AOU, FMA-hand scores, and walking aid. The FMA-hand score was the best predictor of ARAT scores, which can predict a 36.4% variance of ARAT scores in people with stroke, which controlled the effect of using a walking aid. After controlling for use of a walking aid and FMA-hand scores, the multiple linear regression modeling showed that MAL-QOM and MAL-AOU scores could also independently predict an additional 10.4% of the variance in ARAT scores.

Conclusion: In addition to the FMA-hand score, the MAL score was significantly correlated with the ARAT score. Improving self-perceived performance should be one goal of rehabilitation in people with stroke. Further work developing and testing techniques to do so is clearly warranted.

Introduction

Functional performance of the upper limb refers to the performance of using the arms and hands in the tasks of daily life (1). At least one-third of stroke survivors fail to regain full upper limb motor function within 6 months after their stroke (2–4) due to muscle weakness, abnormal muscle tone, or poor upper limb coordination (5). Improving the functional performance of the upper limbs and reducing the associated negative impacts in daily life are often the main goals of stroke rehabilitation (6, 7).

The action research arm test (ARAT) is a reliable and valid upper limb-specific instrument for evaluating the arm and hand functioning of people with neurological disorders, including stroke (8, 9), traumatic brain injury (10), multiple sclerosis (11, 12), and Parkinson's disease (13, 14). The ARAT quantifies the ability to grasp, grip, and pinch, and also perform gross arm movements with objects of different sizes, weights, and shapes.

Previous studies, Platz et al. (11), De Weerdt and Harrison (15), Rabadi and Rabadi (16), and Kwakkel and Kollen (17) have revealed that motor impairment limits the paretic upper limb's functioning in people with stroke. Muscle weakness, abnormal reflexes, and motor coordination, quantified using the Fugl–Meyer Assessment of the upper extremities (FMA-UE) score, were all significantly correlated with ARAT score in people with stroke (r = 0.77–0.925) (11, 15, 16). Furthermore, Kwakkel and Kollen (17) have shown that the hand subscale of the FMA (FMA-hand) is the best predictor of improvement in ARAT results in people with stroke (standardized β = 0.357; p ≤ 0.001). The arm, leg, and balance ability subscales show less predictive power (β ≤ 0.007; p ≤ 0.001). However, the independent contribution of FMA-hand to ARAT score has not been systematically investigated and quantified when the demographic data were also considered.

Self-perceived performance is a subjective feeling of how well and satisfied the people perceive their performance (18), rather than objective performance in real life. The low level of self-perceived performance is indeed associated with the objective performance in people with stroke (19, 20). Van der Lee et al. (19) has demonstrated a significant and moderate to good correlation (r = 0.63, p ≤ 0.001) between motor activity log (MAL) and ARAT scores in people with stroke. Poor self-perceived performance of the upper limb discourages the use of the paretic upper limb (21), which impedes the recovery of the limb's motor skills, leading to even less self-perceived performance, and a downward spiral in upper limb functioning, objectively measured. That makes it important to identify the individual contribution of self-perceived performance to real performance of upper limb in developing rehabilitation programs for people with stroke. However, no proper evaluation of that contribution has yet been published.

This study was therefore designed to determine (1) the correlation of ARAT score (functional performance of upper limb) with MAL (self-perceived performance) and FMA-hand (motor control of hand) scores in people with stroke; (2) whether the MAL score (self-perceived performance) and FMA-hand score (motor control of hand) can independently predict the ARAT score (functional performance of upper limb) in people with stroke, and if so, to quantify the individual contribution of MAL score (self-perceived performance) and FMA-hand score (motor control of hand) when sociodemographic factors are also considered.

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