Evolution and prediction of mismatch between observed and perceived upper limb function after stroke: a prospective, longitudinal, observational cohort study

BMC Neurology

Christophe Lafosse¹  Hilde Beyens²  Fabienne Schillebeeckx²  Annick Van Gils³  Geert Verheyden³  Bea Essers³  Daphne Kos³  Andreas R. Luft⁴  Janne M. Veerbeek⁵  Marc Michielsen⁶ 

[1] Department of Allied Health and Department of Research, Rehabilitation Hospital RevArte, Antwerp, Belgium;Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium;Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium;Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland;Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland;Luzerner Kantonsspital, Neurocenter, Lucerne, Switzerland;Rehabilitation Campus Sint Ursula, Jessa Hospital, Hasselt, Belgium;

关键词: Stroke;    Upper limb;    Outcome;   

DOI  :  10.1186/s12883-021-02493-1

来源: Springer

【 摘 要 】

BackgroundA previously shown ‘mismatch’ group of patients with good observed upper limb (UL) motor function but low perceived UL activity at six months post stroke tends to use the affected UL less in daily life than would be expected based on clinical tests, and this mismatch may also be present at 12 months. We aimed to confirm this group in another cohort, to investigate the evolution of this group from six to 12 months, and to determine factors on admission to inpatient rehabilitation and at 6 months that can discriminate between mismatch and good match groups at 12 months.MethodsPersons after stroke were recruited on rehabilitation admission and re-assessed at six and 12 months. Observed UL function was measured with the upper extremity subscale of the Fugl-Meyer Assessment (FMA-UE) and perceived UL activity by the hand subscale of the Stroke Impact Scale 3.0 (SIS-Hand). We defined mismatch as good observed UL function (FMA-UE > 50/66) but low perceived activity (SIS-Hand≤75/100). Potential discriminators at admission and 6 months (demographic characteristics, stroke characteristics, UL somatosensory function, cognitive deficits, mental function and activity) were statistically compared for match and mismatch groups at 12 months.ResultsWe included 60 participants (female: 42%) with mean (SD) age of 65 (12) years. We confirmed a mismatch group of 11 (18%) patients at 6 months, which increased to 14 (23%) patients at 12 months. In the mismatch group compared to the good match group at 12 months, patients had a higher stroke severity and more somatosensory impairments on admission and at 6 months.ConclusionsWe confirmed a group of patients with good observed UL function but low perceived activity both at six and at 12 months post stroke. Assessment of stroke severity and somatosensory impairments on admission into rehabilitation could determine mismatch at 12 months and might warrant intervention. However, large differences in clinical outcomes between patients in the mismatch group indicate the importance of tailoring training to the individual needs.

【 授权许可】

CC BY