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.
Keywords
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 26, 2019
Footnotes
Supported in part by the National Health Research Institutes (grant no. NHRI-EX107-10403PI) and the Ministry of Science and Technology (grant nos. MOST 107-2314-B-002-052 and MOST 108-2314-B-002-165-MY3) in Taiwan.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
