Original research| Volume 101, ISSUE 3, P442-449, March 2020

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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
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Wan-wen Liao
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Yu-wei Hsieh
    Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan

    Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
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  • Keh-chung Lin
    Corresponding author Keh-chung Lin, ScD, OTR, School of Occupational Therapy, College of Medicine, National Taiwan University, and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 17, F4, Xu Zhou Rd, 10055, Taipei, Taiwan.
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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  • Chia-ling Chen
    Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan

    Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Published:September 26, 2019DOI:



      To identify the predictors of minimal clinically important changes in actual and perceived functional arm use of the affected upper limb after rehabilitative therapy.


      Retrospective, observational cohort study.


      Outpatient rehabilitation settings.


      A cohort of 94 patients with chronic stroke.


      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.


      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.


      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.


      List of abbreviations:

      AOU (amount of use), FMA (Fugl-Meyer Assessment), MAL (Motor Activity Log), MAS (Modified Ashworth Scale), MCID (minimal clinically important difference), MRC (Medical Research Council), MT (mirror therapy), NEADL (Nottingham Extended Activities of Daily Living), OR (odds ratio), QOM (quality of movement), RT (robot-assisted therapy), WMFT (Wolf Motor Function Test), VIF (variance inflation factor)
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