Abstract
We investigated actual daily life upper limb (UL) activity in relation to observed UL motor function and perceived UL activity in chronic stroke in order to better understand and improve UL activity in daily life. In 60 patients, we collected (1) observed UL motor function (Fugl-Meyer Assessment (FMA-UE)), (2) perceived UL activity (hand subscale of the Stroke Impact Scale (SIS-Hand)), and (3) daily life UL activity (bilateral wrist-worn accelerometers for 72 h) data. Data were compared between two groups of interest, namely (1) good observed (FMA-UE >50) function and good perceived (SIS-Hand >75) activity (good match, n = 16) and (2) good observed function but low perceived (SIS-Hand ≤75) activity (mismatch, n = 15) with Mann–Whitney U analysis. The mismatch group only differed from the good match group in perceived UL activity (median (Q1–Q3) = 50 (30–70) versus 93 (85–100); p < 0.001). Despite similar observed UL motor function and other clinical characteristics, the affected UL in the mismatch group was less active in daily life compared to the good match group (p = 0.013), and the contribution of the affected UL compared to the unaffected UL for each second of activity (magnitude ratio) was lower (p = 0.022). We conclude that people with chronic stroke with low perceived UL activity indeed tend to use their affected UL less in daily life despite good observed UL motor function.
Highlights
One of the most important outcomes for stroke survivors, carers, and clinicians is being able to perform everyday tasks, which may be hampered by upper limb (UL) problems [1]
The present study contributes to better understanding of UL activity in the chronic phase post stroke for patients with either a match or a mismatch between observed and perceived UL abilities, which is essential for optimizing UL activity in daily life after stroke
The study confirms that a certain amount of UL motor function is needed for the UL to be active in daily life in the chronic phase post stroke
Summary
One of the most important outcomes for stroke survivors, carers, and clinicians is being able to perform everyday tasks, which may be hampered by upper limb (UL) problems [1]. A limited number of stroke survivors at six months post stroke are able to fully reengage the affected UL in daily activities [2]. In order to re-engage the UL in daily life post stroke, a certain level of UL motor function is needed. Cross-sectional studies in the chronic phase post stroke have shown that patients with low to moderate UL motor function use their paretic UL less in daily life than those with good UL function [3,4,5]. A longitudinal study in the first six months post stroke further shows that affected UL use in daily life increases more in patients with excellent UL function recovery than in those with mild or moderate recovery [4]. It seems that one’s UL motor function needs to reach a threshold in order to use the UL in daily life [5]
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