Functional recovery following stroke: capturing changes in upper-extremity function

Lisa A Simpson, Janice J Eng, Lisa A Simpson, Janice J Eng

Abstract

Background and purpose: Augmenting changes in recovery is core to the rehabilitation process following a stroke. Hence it is essential that outcome measures are able to detect change as it occurs, a property known as responsiveness. This article critically reviewed the responsiveness of functional outcome measures following stroke, specifically examining tools that captured upper-extremity (UE) functional recovery.

Methods: A systematic search of the literature was undertaken to identify articles providing responsiveness data for 3 types of change (observed, detectable, and important).

Results: Data from 68 articles for 14 UE functional outcome measures were retrieved. Larger percentage changes were required to be considered important when obtained through anchor-based methods (eg, based on patient opinion or comparative measure) compared with distribution methods (eg, statistical estimates). Larger percentage changes were required to surpass the measurement error for patient-perceived functional measures (eg, Motor Activity Log) compared with laboratory-based performance measures (eg, Action Research Arm Test). The majority of rehabilitation interventions have similar effect sizes on patient-perceived UE function and laboratory-based UE function.

Conclusions: The magnitude of important change or change that surpasses measurement error can vary substantially depending on the method of calculation. Rehabilitation treatments can affect patient perceptions of functional change as effectively as laboratory-based functional measures; however, larger sample sizes may be required to account for the larger measurement error associated with patient-perceived functional measures.

Figures

Figure 1
Figure 1
Graphic representation of observed, important and detectable change Abbreviations: MDC90: minimal detectable change (with 90% confidence interval); MDC95: minimal detectable change (with 95% confidence interval); LOA: limits of agreement; PES: population effect size; SRM: standardized response mean; MCID: minimally clinically important difference
Figure 2
Figure 2
Flow diagram of process to select final list of outcome measures Abbreviations: OM: outcome measure; AMAT: Arm Motor Activity Test; ARAT: Action Research Arm Test; CAHAI: Chedoke Arm and Hand Activity Inventory; Duruoz: Durouz Hand Index; Frenchay: Frenchay Arm Test; FTHUE: Functional Test for the Hemiplegic Upper Extremity; Jebsen: Jebsen Hand Function Test; MAL: Motor Activity Log; SIS: Stroke Impact Scale; TEMPA: Upper Extremity Performance Scale for the Elderly; Wolf: Wolf Motor Function Test
Figure 3
Figure 3
Effect sizes by measure calculated at athe full range of the effect sizes for the Frenchay is 0.2–5. Abbreviations: Wolf: Wolf Motor Function Test; Duruoz: Duruoz Hand Index; TEMPA: Upper Extremity Performance Scale for the Elderly; FTHUE: Functional Test for the Hemiplegic Upper Extremity; Jebsen: Jebsen Hand Function Test; CAHAI: Chedoke Arm and Hand Inventory; SIS: Stroke Impact Scale (hand scale); ARAT: Action Research Arm Test; Frenchay: Frenchay Arm Test
Figure 4
Figure 4
Comparison of observed change captured by ‘lab-based’ versus ‘patient-perceived functional measures Points on the graph represent the effect sizes obtained from a single study. Lines on the graph represent a 1:1 relationship between the ‘lab-based’ vs ‘patient-perceived’ functional measures. Lab-based measures are located on the X-axes (ie. Wolf, ARAT). Patient-perceived functional measures are located on the Y axes (ie. MAL). Abbreviations: MAL: Motor Activity Log; AOU: amount of use scale; QOM: quality of movement scale; CIMT: ARAT: Action Research Arm Test; Wolf: Wolf Motor Function Test; FAS: functional ability scale
Figure 5
Figure 5
Comparison of detectable change (calculated at 95% confidence level) relative to the sample means and scale maximums The bars beside each measure represent the range of MDC95%values extracted or calculated from different studies. *Two studies analysed different subsets of the same sample to obtain multiple estimates. ϯEstimates for the ARAT, Wolf (FAS) and SIS are missing from this graph as sample means were not provided in two studies., Abbreviations: MDC95%: Minimally detectable change (with a 95% confidence interval) expressed as a percentage of A: the scale maximum score and B: the sample means; MAL: Motor Activity Log; AOU: amount of use scale; SIS: Stroke Impact Scale (hand); QOM: quality of movement scale; TEMPA: Upper Extremity Performance Scale for the Elderly; AMAT: Arm Motor Ability Test; FAS: functional

References

    1. Beaton DE, Bombardier C, Katz JN, Wright JG. A taxonomy for responsiveness. J Clin Epidemiol. 2001;54:1204–1217.
    1. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63:737–745.
    1. Kain ZN, MacLaren J. P less than. 05: What does it really mean? Pediatrics. 2007;119:608.
    1. Hopewell S, Clarke M, Lefebvre C, Scherer R. Handsearching versus electronic searching to identify reports of randomized trials. Cochrane Database Syst Rev. 2007;(4)
    1. Morris SB, DeShon RP. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods. 2002;7:105–125.
    1. Stratford PW. Getting more from the literature: estimating the standard error of measurement from reliability studies. Physiother Can. 2004;56:27–30.
    1. Flansbjer UB, Holmbäck AM, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med. 2005;37:75–82.
    1. Angst F. The new COSMIN guidelines confront traditional concepts of responsiveness. BMC Med Res Methodol. 2011;11:152.
    1. Hozo S, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.
    1. Beebe JA, Lang CE. Relationships and responsiveness of six upper extremity function tests during the first six months of recovery after stroke. J Neurol Phys Ther. 2009;33:96–103.
    1. Hsueh I, Hsieh C. Responsiveness of two upper extremity function instruments for stroke inpatients receiving rehabilitation. Clin Rehabil. 2002;16:617–624.
    1. Lin JH, Hsu MJ, Sheu CF, et al. Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke. Phys Ther. 2009;89:840–850.
    1. Rabadi MH, Rabadi FM. Comparison of the action research arm test and the fugl-meyer assessment as measures of upper-extremity motor weakness after stroke. Arch Phys Med Rehabil. 2006;87:962–966.
    1. Barreca SR, Stratford PW, Masters LM, Lambert CL, Griffiths J, McBay C. Validation of three shortened versions of the Chedoke Arm and Hand Activity Inventory. Physiotherapy Canada. 2006;58:148–156.
    1. Barreca SR, Stratford PW, Lambert CL, Masters LM, Streiner DL. Test-retest reliability, validity, and sensitivity of the Chedoke Arm and Hand Activity Inventory: a new measure of upper-limb function for survivors of stroke. Arch Phys Med Rehabil. 2005;86:1616–1622.
    1. Barreca SR, Stratford PW, Masters LM, Lambert CL, Griffiths J. Comparing 2 versions of the Chedoke Arm and Hand Activity Inventory with the Action Research Arm Test. Phys Ther. 2006;86:245–253.
    1. Pandyan AD, Cameron M, Powell J, Stott DJ, Granat MH. Contractures in the post-stroke wrist: a pilot study of its time course of development and its association with upper limb recovery. Clin Rehabil. 2003;17:88–95.
    1. Brunner IC, Skouen JS, Strand LI. Recovery of upper extremity motor function post stroke with regard to eligibility for constraint-induced movement therapy. Top Stroke Rehabil. 2011;18:248–257.
    1. Au-Yeung SS, Hui-Chan CW. Predicting recovery of dextrous hand function in acute stroke. Disabil Rehabil. 2009;31:394–401.
    1. Rand D, Eng JJ. Disparity between functional recovery and daily use of the upper and lower extremities during subacute stroke rehabilitation. Neurorehabil Neural Repair. 2012;26:76–84.
    1. Roiha K, Kirveskari E, Kaste M, et al. Reorganization of the primary somatosensory cortex during stroke recovery. Clin Neurophysiol. 2011;122:339–345.
    1. Blennerhassett JM, Avery RM, Carey LM. The test-retest reliability and responsiveness to change for the Hand Function Survey during stroke rehabilitation. Aust Occup Ther J. 2010;57:431–438.
    1. Rehme AK, Fink GR, von Cramon DY, Grefkes C. The role of the contralesional motor cortex for motor recovery in the early days after stroke assessed with longitudinal FMRI. Cereb Cortex. 2011;21:756–768.
    1. Filiatrault J, Arsenault AB, Dutil E, Bourbonnais D. Motor function and activities of daily living assessments: a study of three tests for persons with hemiplegia. Am J Occup Ther. 1991;45:806–810.
    1. Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The Stroke Impact Scale version 2.0. evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30:2131–2140.
    1. Kamel A, Ghani AA, Zaiton MA, El-Motayam AS, El-Fattah DA. Health related quality of life in stroke survivors measured by the Stroke Impact Scale. Egypt J of Neurol Psychiat Neurosurg. 2010;47:267–274.
    1. Sezer N, Yavuzer G, Sivrioglu K, Basaran P, Koseoglu BF. Clinimetric properties of the Duruoz Hand Index in patients with stroke. Arch Phys Med Rehabil. 2007;88:309–314.
    1. Bouffioulx É, Arnould C, Thonnard JL. Satisfaction with activity and participation and its relationships with body functions, activities, or environmental factors in stroke patients. Arch Phys Med Rehabil. 2011;92s:1404–1410.
    1. Rand D, Gottlieb D, Weiss P. Recovery of patients with a combined motor and proprioception deficit during the first six weeks of post stroke rehabilitation. Phys Occup Ther Geratr. 2001;18:69–87.
    1. Wittenberg GF, Bastings EP, Fowlkes AM, Morgan TM, Good DC, Pons TP. Dynamic course of intracortical TMS paired-pulse responses during recovery of motor function after stroke. Neurorehabil Neural Repair. 2007;21:568–573.
    1. Higgins J, Mayo NE, Desrosiers J, Salbach NM, Ahmed S. Upper-limb function and recovery in the acute phase poststroke. J Rehabil Res Dev. 2005;42:65–76.
    1. Mayo NE, Wood-Dauphinee S, Ahmed S, et al. Disablement following stroke. Disabil Rehabil. 1999;21:258–268.
    1. Desrosiers J, Malouin F, Richards C, Bourbonnais D, Rochette A, Bravo G. Comparison of changes in upper and lower extremity impairments and disabilities after stroke. Int J Rehabil Res. 2003;26:109–116.
    1. Feydy A, Carlier R, Roby-Brami A, et al. Longitudinal study of motor recovery after stroke: Recruitment and focusing of brain activation. Stroke. 2002;33:1610–1617.
    1. Hsu SS, Hu MH, Wang YH, Yip PK, Chiu JW, Hsieh CL. Dose-response relation between neuromuscular electrical stimulation and upper-extremity function in patients with stroke. Stroke. 2010;41:821–824.
    1. Page SJ, Levine P, Leonard AC. Modified constraint-induced therapy in acute stroke: A randomized controlled pilot study. Neurorehabil Neural Repair. 2005;19:27–32.
    1. Sun SF, Hsu CW, Sun HP, Hwang CW, Yang CL, Wang JL. Combined botulinum toxin type A with modified constraint-induced movement therapy for chronic stroke patients with upper extremity spasticity: a randomized controlled study. Neurorehabil Neural Repair. 2010;24:34–41.
    1. Myint JM, Yuen GF, Yu TK, et al. A study of constraint-induced movement therapy in subacute stroke patients in Hong Kong. Clin Rehabil. 2008;22:112–124.
    1. van der Lee JH, Wagenaar RC, Lankhorst GJ, Vogelaar TW, Deville WL, Bouter LM. Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke. 1999;30:2369–2375.
    1. Harris JE, Eng JJ, Miller WC, Dawson AS. A self-administered graded repetitive arm supplementary program (GRASP) improves arm function during inpatient stroke rehabilitation: A multi-site randomized controlled trial. Stroke. 2009;40:2123–2128.
    1. Shindo K, Fujiwara T, Hara J, et al. Effectiveness of hybrid assistive neuromuscular dynamic stimulation therapy in patients with subacute stroke. Neurorehabil Neural Repair. 2011;25:830–837.
    1. Dahl AE, Askim T, Stock R, Langorgen E, Lydersen S, Indredavik B. Short- and long-term outcome of constraint-induced movement therapy after stroke: a randomized controlled feasibility trial. Clin Rehabil. 2008;22:436–447.
    1. Cacchio A, De Blasis E, De Blasis V, Santilli V, Spacca G. Mirror therapy in complex regional pain syndrome type 1 of the upper limb in stroke patients. Neurorehabil Neural Repair. 2009;23:792–799.
    1. Kowalczewski J, Gritsenko V, Ashworth N, Ellaway P, Prochazka A. Upper-extremity functional electric stimulation-assisted exercises on a workstation in the subacute phase of stroke recovery. Arch Phys Med Rehabil. 2007;88:833–839.
    1. Pang MY, Harris JE, Eng JJ. A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2006;87:1–9.
    1. Taub E, Uswatte G, King DK, Morris D, Crago JE, Chatterjee A. A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke. 2006;37:1045–1049.
    1. Wittenberg GF, Chen R, Ishii K, et al. Constraint-induced therapy in stroke: magnetic-stimulation motor maps and cerebral activation. Neurorehabil Neural Repair. 2003;17:48–57.
    1. Wu CY, Chuang LL, Lin KC, Chen HC, Tsay PK. Randomized trial of distributed constraint-induced therapy versus bilateral arm training for the rehabilitation of upper-limb motor control and function after stroke. Neurorehabil Neural Repair. 2011;25:130–139.
    1. Gauthier LV, Taub E, Perkins C, Ortmann M, Mark VW, Uswatte G. Remodeling the brain: plastic structural brain changes produced by different motor therapies after stroke. Stroke. 2008;39:1520–1525.
    1. Khan CM, Oesch PR, Gamper UN, Kool JP, Beer S. Potential effectiveness of three different treatment approaches to improve minimal to moderate arm and hand function after stroke: a pilot randomized clinical trial. Clin Rehabil. 2011;25:1032–1041.
    1. Tariah HA, Almalty A, Sbeih Z, Al-Oraibi S, Bernhardt J, Rowe V. Constraint induced movement therapy for stroke survivors in Jordon: a home-based model. Int J Ther Rehabil. 2010;17:638–646.
    1. Dromerick AW, Lang CE, Birkenmeier RL, et al. Very early constraint-induced movement during stroke rehabilitation (VECTORS): A single-center RCT. Neurology. 2009;73:195–201.
    1. Church C, Price C, Pandyan AD, Huntley S, Curless R, Rodgers H. Randomized controlled trial to evaluate the effect of surface neuromuscular electrical stimulation to the shoulder after acute stroke. Stroke. 2006;37:2995–3001.
    1. Wu CY, Chen CL, Tsai WC, Lin KC, Chou SH. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Arch Phys Med Rehabil. 2007;88:273–278.
    1. Kimberley TJ, Lewis SM, Auerbach EJ, Dorsey LL, Lojovich JM, Carey JR. Electrical stimulation driving functional improvements and cortical changes in subjects with stroke. Exp Brain Res. 2004;154:450–460.
    1. Lin KC, Chang YF, Wu CY, Chen YA. Effects of constraint-induced therapy versus bilateral arm training on motor performance, daily functions, and quality of life in stroke survivors. Neurorehabil Neural Repair. 2009;23:441–448.
    1. Lin KC, Wu CY, Liu JS, Chen YT, Hsu CJ. Constraint-induced therapy versus dose-matched control intervention to improve motor ability, basic/extended daily functions, and quality of life in stroke. Neurorehabil Neural Repair. 2009;23:160–165.
    1. Ertelt D, Small S, Solodkin A, et al. Action observation has a positive impact on rehabilitation of motor deficits after stroke. Neuroimages. 2007;36:T164–T173.
    1. Conroy SS, Whitall J, Dipietro L, et al. Effect of gravity on robot-assisted motor training after chronic stroke: a randomized trial. Arch Phys Med Rehabil. 2011;92:1754–1761.
    1. Liao WW, Wu CY, Hsieh YW, Lin KC, Chang WY. Effects of robot-assisted upper limb rehabilitation on daily function and real-world arm activity in patients with chronic stroke: a randomized controlled trial. Clin Rehabil. 2012;26:111–120.
    1. Page SJ, Levin L, Hermann V, Dunning K, Levine P. Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke. Arch Phys Med Rehabil. 2012;93:200–206.
    1. Hsieh YW, Wu CY, Liao WW, Lin KC, Wu KY, Lee CY. Effects of treatment intensity in upper limb robot-assisted therapy for chronic stroke: A pilot randomized controlled trial. Neurorehabil Neural Repair. 2011;25:503–511.
    1. Fritz SL, George SZ, Wolf SL, Light KE. Participant perception of recovery as criterion to establish importance of improvement for constraint-induced movement therapy outcome measures: a preliminary study. Phys Ther. 2007;87:170–178.
    1. Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW. Estimating minimal clinically important differences of upper-extremity measures early after stroke. Arch Phys Med Rehabil. 2008;89:1693–1700.
    1. Wang TN, Lin KC, Wu CY, Chung CY, Pei YC, Teng YK. Validity, responsiveness, and clinically important difference of the ABILHAND questionnaire in patients with stroke. Arch Phys Med Rehabil. 2011;92:1086–1091.
    1. Lin KC, Fu T, Wu CY, et al. Minimal detectable change and clinically important difference of the Stroke Impact Scale in stroke patients. Neurorehabil Neural Repair. 2010;24:486–492.
    1. Lin KC, Hsieh YW, Wu CY, Chen CL, Jang Y, Liu JS. Minimal detectable change and clinically important difference of the Wolf Motor Function Test in stroke patients. Neurorehabil Neural Repair. 2009;23:429–434.
    1. Fritz SL, Blanton S, Uswatte G, Taub E, Wolf SL. Minimal detectable change scores for the Wolf Motor Function Test. Neurorehabil Neural Repair. 2009;23:662–667.
    1. Wolf SL, Thompson PA, Morris DM, et al. The EXCITE trial: attributes of the Wolf Motor Function Test in patients with subacute stroke. Neurorehabil Neural Repair. 2005;19:194–205.
    1. Uswatte G, Giuliani C, Winstein C, Zeringue A, Hobbs L, Wolf SL. Validity of accelerometry for monitoring real-world arm activity in patients with subacute stroke: evidence from the extremity constraint-induced therapy evaluation trial. Arch Phys Med Rehabil. 2006;87:1340–1345.
    1. Uswatte G, Taub E, Morris D, Vignolo M, McCulloch K. Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use. Stroke. 2005;36:2493–2496.
    1. Uswatte G, Taub E, Morris D, Light K, Thompson PA. The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke. Neurology. 2006;67:1189–1194.
    1. Kopp B, Kunkel A, Flor H, et al. The Arm Motor Ability Test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living. Arch Phys Med Rehabil. 1997;78:615–620.
    1. Richards L, Stoker-Yates J, Pohl P, Wallace D, Duncan P. Reliability and validity of two tests of upper extremity motor function post-stroke. Occup Ther J Res. 2001;21:201–219.
    1. Carod-Artal FJ, Coral LF, Trizotto DS, Moreira CM. The Stroke Impact Scale 3. 0: Evaluation of acceptability, reliability, and validity of the Brazilian version. Stroke. 2008;39:2477–2484.
    1. van der Lee JH, Beckerman H, Knol DL, De Vet HC, Bouter LM. Clinimetric properties of the Motor Activity Log for the assessment of arm use in hemiparetic patients. Stroke. 2004;35:1410.
    1. van der Lee JH, Beckerman H, Lankhorst GJ, Bouter LM. The responsiveness of the Action Research Arm Test and the Fugl-Meyer assessment scale in chronic stroke patients. J Rehabil Med. 2001;33:110–113.
    1. Lydick E, Epstein RS. Interpretation of quality of life changes. Qual Life Res. 1993;2:221–226.
    1. Biernaskie J, Chernenko G, Corbett D. Efficacy of rehabilitative experience declines with time after focal ischemic brain injury. J Neurosci. 2004;24:1245–1254.
    1. Dobkin BH, Dorsch A. The promise of mHealth: daily activity monitoring and outcome assessments by wearable sensors. Neurorehabil Neural Repair. 2011;25:788–798.
    1. Mokkink L, Terwee C, Knol D, et al. The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol. 2010;10:22.
    1. Revicki D, Hays RD, Cella D, Sloan J. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008;61:102–109.
    1. Guyatt GH, Norman GR, Juniper EF, Griffith LE. A critical look at transition ratings. J Clin Epidemiol. 2002;55:900–908.
    1. Salter K, Jutai J, Teasell R, Foley N, Bitensky J, Bayley M. Issues for selection of outcome measures in stroke rehabilitation: ICF activity. Disabil Rehabil. 2005;27:315–340.
    1. Terwee CB, Bot SDM, De Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34–42.
    1. Wyrwich KW, Tierney WM, Wolinksy FD. Further evidence supporting standard error of measurement based criterion for identifying meaningful intra-individual change in health-related quality of life. J Clin Epidemiol. 1999;52:861–873.
    1. Turner D, Schunemann HJ, Griffith LE, et al. The minimal detectable change cannot reliably replace the minimal important difference. J Clin Epidemiol. 2010:63-28-36.
    1. Stucki G, Daltroy L, Katz JN, Johannesson M, Liang MH. Interpretation of change scores in ordinal clinical scales and health status measures: The whole may not equal the sum of the parts. J Clin Epidemiol. 1996;49:711–717.
    1. Streiner DLNG. Health measurement scales: A practical guide to their development and use. 4. New York: Oxford University Press; 2008.

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