A cross sectional study of upper extremity strength ten days after a stroke; relationship between patient-reported and objective measures

Hanna C Persson, Anna Danielsson, Katharina S Sunnerhagen, Hanna C Persson, Anna Danielsson, Katharina S Sunnerhagen

Abstract

Background: Reduced upper extremity function early after a stroke is common, and a combination of strength capacity and patient-reported measures contribute to setting realistic goals. The validity of the patient's perception of upper extremity strength in relation to objective strength assessments early after a stroke needs to be clarified. The objective was to investigate the relationship between perceived upper extremity strength and measured hand strength at ten days post-stroke.

Methods: This study of 99 patients with reduced upper extremity function at 3 days post stroke, were consecutively included from a stroke unit to the Stroke Arm Longitudinal Study at the University of Gothenburg, (the SALGOT-study). The correlations between two questions from the Stroke Impact Scale (SIS 1a and 1b), and a dynamometer measure of hand strength values (percentage of normative values) were investigated. In order to explain differences between the two types of measurements, the accordance between perceived strength in a dichotomized SIS and objective measures was explored. In SIS 1a and 1b, 1-3 points correspond to reduced strength (<80% or normative strength values). In SIS 1a and 1b, 4-5 points correspond to normal strength (≥ 80% of normative strength values).

Results: The correlation between the measured strength values and perceived arm strength was rho 0.82 (p = <0.001) and with perceived grip strength rho 0.87 (p = <0.001). Using the dichotomized SIS and the 80% cut-off correctly classified arm strength in 81% and grip strength in 84% of the patients, with a sensitivity of 0.86-0.87, a specificity of 0.62-0.77, positive predicted values of 0.87-0.91 and negative predicated values of 0.64-0.67.

Discussion: The discrepancy between assessed strength capacity and self-perceived strength highlights the importance of including self-perceived assessments early after stroke, in order to increase knowledge of a patient's awareness of functioning or lack thereof.

Conclusions: Ten days after stroke in patients without severe cognitive disabilities, this study suggests that despite high correlations between measures, an objective assessment of arm and hand strength does not always reflect the patient's perspective. A combination of self-reported and objective strength assessment is requested to enhance in setting of realistic goals early after stroke.

Trial registration: ClinicalTrials.gov: NCT01115348, May 3, 2010.

Figures

Fig. 1
Fig. 1
Objective strength at different levels of perceived strength in the paretic arm and hand. a illustrates objective strength (percentages of normative dynamometer strength values) in relation to self-reported arm strength. b illustrates the objective strength in the relation to self-reported hand strength. Abbreviations: Dynamometer; JAMAR Hand Dynamometer; SIS, Stroke Impact Scale questions 1A and 1B

References

    1. Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, Carlsson J, Dahlin-Ivanoff S, Johansson IL, Kjellgren K, et al. Person-centered care--ready for prime time. Eur J Cardiovasc Nurs. 2011;10(4):248–51. doi: 10.1016/j.ejcnurse.2011.06.008.
    1. Donnellan C, Martins A, Conlon A, Coughlan T, O'Neill D, Collins DR. Mapping patients' experiences after stroke onto a patient-focused intervention framework. Disabil Rehabil. 2013;35(6):483–91. doi: 10.3109/09638288.2012.702844.
    1. Stewart JC, Cramer SC. Patient-reported measures provide unique insights into motor function after stroke. Stroke. 2013;44(4):1111–6. doi: 10.1161/STROKEAHA.111.674671.
    1. van Delden AL, Peper CL, Beek PJ, Kwakkel G. Match and mismatch between objective and subjective improvements in upper limb function after stroke. Disabil Rehabil. 2013;35(23):1961–7. doi: 10.3109/09638288.2013.768303.
    1. Velstra IM, Ballert CS, Cieza A. A systematic literature review of outcome measures for upper extremity function using the international classification of functioning, disability, and health as reference. Pm R. 2011;3(9):846–60. doi: 10.1016/j.pmrj.2011.03.014.
    1. Stroke Unit Trialists C Organised inpatient (stroke unit) care for stroke. The Cochrane Database Of Systematic Reviews. 2013;9:CD000197.
    1. Bernhardt J, Indredavik B, Langhorne P. When should rehabilitation begin after stroke? Int J Stroke. 2013;8(1):5–7. doi: 10.1111/ijs.12020.
    1. Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75(4):394–8. doi: 10.1016/0003-9993(94)90161-9.
    1. Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34(9):2181–6. doi: 10.1161/.
    1. Heller A, Wade DT, Wood VA, Sunderland A, Hewer RL, Ward E. Arm function after stroke: measurement and recovery over the first three months. J Neurol Neurosurg Psychiatry. 1987;50(6):714–9. doi: 10.1136/jnnp.50.6.714.
    1. Sunderland A, Tinson D, Bradley L, Hewer RL. Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator. J Neurol Neurosurg Psychiatry. 1989;52(11):1267–72. doi: 10.1136/jnnp.52.11.1267.
    1. Boissy P, Bourbonnais D, Carlotti MM, Gravel D, Arsenault BA. Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function. Clin Rehabil. 1999;13(4):354–62. doi: 10.1191/026921599676433080.
    1. Hartman-Maeir A, Soroker N, Ring H, Katz N. Awareness of deficits in stroke rehabilitation. J Rehabil Med. 2002;34(4):158–64. doi: 10.1080/16501970213236.
    1. Alt Murphy M, Persson HC, Danielsson A, Broeren J, Lundgren-Nilsson A, Sunnerhagen KS. SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol. BMC Neurol. 2011;11(1):56. doi: 10.1186/1471-2377-11-56.
    1. Lyle RC. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res. 1981;4(4):483–92. doi: 10.1097/00004356-198112000-00001.
    1. Hsieh CL, Hsueh IP, Chiang FM, Lin PH. Inter-rater reliability and validity of the action research arm test in stroke patients. Age Ageing. 1998;27(2):107–13. doi: 10.1093/ageing/27.2.107.
    1. Yozbatiran N, Der-Yeghiaian L, Cramer SC. A standardized approach to performing the action research arm test. Neurorehabil Neural Repair. 2008;22(1):78–90. doi: 10.1177/1545968307305353.
    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(10):2131–40. doi: 10.1161/01.STR.30.10.2131.
    1. Duncan PW, Bode RK, Min Lai S, Perera S. Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale. Arch Phys Med Rehabil. 2003;84(7):950–63. doi: 10.1016/S0003-9993(03)00035-2.
    1. Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am. 1984;9(2):222–6. doi: 10.1016/S0363-5023(84)80146-X.
    1. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69–74.
    1. Brott T, Adams HP, Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–70. doi: 10.1161/01.STR.20.7.864.
    1. Cumming TB, Blomstrand C, Bernhardt J, Linden T. The NIH stroke scale can establish cognitive function after stroke. Cerebrovasc Dis. 2010;30(1):7–14. doi: 10.1159/000313438.
    1. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13–31.
    1. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983;63(10):1606–10.
    1. Denvall V, Elmstahl S, Prigatano GP. Replication and construct validation of the Barrow Neurological Institute Screen for Higher Cerebral Function with a Swedish population. J Rehabil Med. 2002;34(4):153–7. doi: 10.1080/16501970213231.
    1. Asplund K, Hulter Asberg K, Appelros P, Bjarne D, Eriksson M, Johansson A, Jonsson F, Norrving B, Stegmayr B, Terent A, et al. The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care. Int J Stroke. 2011;6(2):99–108. doi: 10.1111/j.1747-4949.2010.00557.x.
    1. Hollander M, Wolfe DA. Nonparametric statistical methods. 2. New York, NY: John Wiley & Sons; 1999.
    1. Dromerick AW, Lang CE, Birkenmeier R, Hahn MG, Sahrmann SA, Edwards DF. Relationships between upper-limb functional limitation and self-reported disability 3 months after stroke. J Rehabil Res Dev. 2006;43(3):401–8. doi: 10.1682/JRRD.2005.04.0075.
    1. Coman L, Richardson J. Relationship between self-report and performance measures of function: a systematic review. Can J Aging. 2006;25(3):253–70. doi: 10.1353/cja.2007.0001.
    1. Lin KC, Fu T, Wu CY, Hsieh YW, Chen CL, Lee PC. Psychometric comparisons of the Stroke Impact Scale 3.0 and Stroke-Specific Quality of Life Scale. Qual Life Res. 2010;19(3):435–43. doi: 10.1007/s11136-010-9597-5.
    1. Guidetti S, Ytterberg C, Ekstam L, Johansson U, Eriksson G. Changes in the impact of stroke between 3 and 12 months post-stroke, assessed with the Stroke Impact Scale. J Rehabil Med. 2014;46(10):963–8. doi: 10.2340/16501977-1865.
    1. Bohannon RW. Manual muscle testing: does it meet the standards of an adequate screening test? Clin Rehabil. 2005;19(6):662–7. doi: 10.1191/0269215505cr873oa.
    1. Bohannon RW. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil. 1997;78(1):26–32. doi: 10.1016/S0003-9993(97)90005-8.
    1. Barrett AM. Rose-colored answers: neuropsychological deficits and patient-reported outcomes after stroke. Behav Neurol. 2010;22(1–2):17–23. doi: 10.1155/2010/628257.

Source: PubMed

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