Background

A major goal of upper limb (UL) rehabilitation after stroke is to facilitate the use of the paretic arm in daily life activities.

Purpose

To examine if UL impairment two weeks after stroke can predict real-life UL use at three months. Furthermore, to identify additional factors which contribute to future UL use, and characteristics of patients who do not achieve normal UL use.

Methods

This study included patients with stroke ≥ 18 years. UL impairment was assessed by Fugl-Meyer upper extremity motor assessment (FM). Use ratio between affected and unaffected UL was assessed with accelerometers at three months after stroke. The association between FM score and UL use ratio was investigated with linear regression models and adjusted for secondary variables. Non-normal use was examined by a logistic regression.

Results

Eighty-seven patients were included. FM score two weeks after stroke predicted 38% of the variance in UL use ratio three months after stroke. A multivariate regression model predicted 55%, and the significant predictors were FM, motor-evoked potential (MEP) status, and neglect. Non-normal use could be predicted with a high accuracy based on MEP and/or neglect. In a logistic regression sensitivity for prediction of non-normal use was 0.93 and specificity was 0.75.

Conclusion

Better baseline capacity of the paretic UL predicted increased use of the arm and hand in daily life. Non-normal UL use could be predicted reliably based on the absence of MEPs and/or presence of neglect.

中文翻译：

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预测中风后三个月的上肢使用情况：一项前瞻性纵向研究

背景

中风后上肢 (UL) 康复的主要目标是促进瘫痪手臂在日常生活活动中的使用。

目的

检查中风后两周的 UL 损伤是否可以预测三个月时的真实 UL 使用。此外，确定有助于未来 UL 使用的其他因素，以及未达到正常 UL 使用的患者的特征。

方法

该研究纳入了≥18 岁的卒中患者。UL 损伤通过 Fugl-Meyer 上肢运动评估 (FM) 进行评估。在中风后三个月用加速度计评估受影响和未受影响的 UL 之间的使用比率。使用线性回归模型研究了 FM 评分和 UL 使用率之间的关联，并针对次要变量进行了调整。通过逻辑回归检查非正常使用。

结果

包括八十七名患者。中风后两周的 FM 评分预测了中风后三个月 UL 使用率变化的 38%。多元回归模型预测了 55%，显着的预测因子是 FM、运动诱发电位 (MEP) 状态和忽视。基于 MEP 和/或忽略，可以高精度地预测非正常使用。在逻辑回归中，预测非正常使用的敏感性为 0.93，特异性为 0.75。

结论

麻痹性 UL 的更好的基线容量预示着日常生活中手臂和手的使用增加。基于 MEP 的缺失和/或忽视的存在，可以可靠地预测非正常 UL 使用。