Abstract
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.
Highlights
A 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 be present at 12 months
We included patients with Fugl-Meyer Assessment upper extremity (FMA-UE) and SIS-Hand values at both six and 12 months, which resulted in a sample of 60 out of 68 patients included at 6 months
We further assumed that stroke severity at rehab admission, age, somatosensory function, activities of daily living (ADL) independence, education and mood could distinguish between mismatch and good match at 12 months
Summary
A 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 be present at 12 months. Essers et al BMC Neurology (2021) 21:488 activities [2] These difficulties remain often present in the chronic phase after stroke (after 6 months [3]) and can lead to a lower level of independence [4] and quality of life [5]. UL functions can be assessed with observationbased assessments, whereby the therapist observes and scores the patient’s function of the UL To these observation-based assessments, patient-reported outcomes might add valuable information. Patient-reported outcomes for the UL reflect how a person subjectively experiences the level of UL activity in the current environment: the perceived UL activity [7]
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