Content » Vol 52, Issue 4

Original report

Comparison of self-reported vs observational clinical measures of improvement in upper limb capacity in patients after stroke

Eline C. C. van Lieshout, Johanna M.A. Visser-Meily, Rinske H. M. Nijland , Rick M. Dijkhuizen, Gert Kwakkel
Imaging, University Medical Center Utrecht and Utrecht University, , Utrecht, The Netherlands
DOI: 10.2340/16501977-2661

Abstract

Objective: Recovery of the paretic arm post-stroke can be assessed using observational and self-reported measures. The aim of this study was to determine whether the correspondence (match) or non-correspondence (mismatch) between observational and self-reported improvements in upper limb capacity are significantly different at 0–3 months compared with 3–6 months post-stroke.
Methods: A total of 159 patients with ischaemic stroke with upper limb paresis were included in the study. Recovery of arm capacity was measured with observational (Action Research Arm Test; ARAT) and self-reported measures (Motor Activity Log Quality of Movement; MAL-QOM and Stroke Impact Scale Hand; SIS-Hand) at 0–3 and 3–6 months post-stroke. The proportion of matches was defined (contingency tables and Fisher’s exact test) and compared across the different time-windows using McNemar’s test.
Results: The proportion of matches was not significantly different at 0–3 months compared with 3–6 months post-stroke for the ARAT vs MAL-QOM and SIS-Hand (all p > 0.05). In case of mismatches, patients’ self-reports were more often pessimistic (86%) in the first 3 months post-stroke compared with the subsequent 3 months (39%).
Conclusion: The match between observational and self-reported measures of upper limb capacity is not dependent on the timing of assessment post-stroke. Assessment of both observational and self-reported measures may help to recognize possible over- or under-estimation of improvement in upper limb capacity post-stroke.

Lay Abstract

One of the most common motor disturbances after stroke is a paretic arm, which may be of little functional use in activities of daily living. Recovery of the paretic arm can be assessed by a clinician (observational) or by the patient (patient-reported). It might be expected that observational and patient-reported measures will be strongly related to each other. The aim of this study was to determine whether the correspondence (matches) between those measures is different at 0–3 months post-stroke compared with 3–6 months post-stroke. The results showed that the time-frame post-stroke (0–3 or 3–6 months) did not seem to influence the correspondence between the observational and self-reported measures: there were more matches than mismatches found. Self-reported measures can be used in addition to observational measures to assess arm recovery. Information on the ability and use of the affected arm outside the treatment setting is valuable for clinicians, as it provides more insight into the patients’ perspective.

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