Jenny Snickars, Hanna C. Persson, Katharina S. Sunnerhagen
Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and PhysiologyUniversity of Gothenburg, 41346 Gothenburg, Sweden. E-mail: jenny.snickars@akademiska.se
DOI: 10.2340/16501977-2205

Objective: To investigate factors within 3 days post-stroke that could predict severe impairment in motor function in the upper extremity at one month post-stroke.
Methods: This cross-sectional study included 104 patients with first-ever stroke and impaired motor function in the upper extremity. Initial impairment in motor function, demographic data, type of stroke and stroke risk factors were chosen as possible predictors. Severe impairment in motor function was defined as ≤ 31p according to the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Logistic regression was used to predict severe impairment in motor function at one month post-stroke.
Results: Three possible prediction models were found, comprising stroke severity combined with grip strength and sex, finger extension or shoulder abduction. Models including grip strength or finger extension gave the most accurate predictions, with overall predictive ability 90. 4% (95% confidence interval (95% CI) 0. 847–0. 961) and sensitivity 92. 9% (95% CI 0. 851–1. 0) and 90. 5% (95% CI 0. 816–0. 979), respectively.
Conclusion: Within 3 days post-stroke, severe impairment in motor function in the upper extremity at one month can be predicted using assessment of stroke severity in combination with grip strength, finger extension or shoulder abduction. This may facilitate early planning of rehabilitation for patients with impaired upper extremity in the stroke unit.

Prediction of severe impairment in arm and hand one month after stroke
Stroke is the most common cause of long term disability in an adult population and one common symptom is reduced function in arm and hand. Recovery can occur in longer terms but mainly takes place during the first month, and therefore planning of rehabilitation needs to start early. This study investigated clinical factors that within three days after stroke can predict severe function impairment in arm and hand after one month. In a cohort of patients with initially reduced arm and hand function, this study showed that stroke severity at stroke onset combined with clinical assessments as grip strength, the ability to lift the shoulder or extend the fingers can predict severe motor function impairment after one month. This knowledge may facilitate the early planning of rehabilitation of patients with impaired upper extremity at the stroke unit.