Estimating the Minimal Clinically Important Difference of an Upper Extremity Recovery Measure in Subacute Stroke Patients

Arya, Kapil; Verma, Rajesh; Garg, RavindraK

doi:10.1310/tsr18s01-599

Cited by 172 publications

(70 citation statements)

References 20 publications

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“…Its score ranges from 0 to 66. The minimal clinical important difference (MCID) for the FM upper extremity section is 9 points (for both the affected dominant and affected non-dominant arm-hand) [28]. …”

Section: Methodsmentioning

confidence: 99%

Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation

2017

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BackgroundArm-hand rehabilitation programs applied in stroke rehabilitation frequently target specific populations and thus are less applicable in heterogeneous patient populations. Besides, changes in arm-hand function (AHF) and arm-hand skill performance (AHSP) during and after a specific and well-described rehabilitation treatment are often not well evaluated.MethodThis single-armed prospective cohort study featured three subgroups of stroke patients with either a severely, moderately or mildly impaired AHF. Rehabilitation treatment consisted of a Concise_Arm_and_hand_ Rehabilitation_Approach_in_Stroke (CARAS). Measurements at function and activity level were performed at admission, clinical discharge, 3, 6, 9 and 12 months after clinical discharge.ResultsEighty-nine stroke patients (M/F:63/23; mean age:57.6yr (+/-10.6); post-stroke time:29.8 days (+/-20.1)) participated. All patients improved on AHF and arm-hand capacity during and after rehabilitation, except on grip strength in the severely affected subgroup. Largest gains occurred in patients with a moderately affected AHF. As to self-perceived AHSP, on average, all subgroups improved over time. A small percentage of patients declined regarding self-perceived AHSP post-rehabilitation.ConclusionsA majority of stroke patients across the whole arm-hand impairment severity spectrum significantly improved on AHF, arm-hand capacity and self-perceived AHSP. These were maintained up to one year post-rehabilitation. Results may serve as a control condition in future studies.

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Section: Methodsmentioning

confidence: 99%

Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation

2017

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“…Improvements in the upper extremity portion of the FMA have been shown in a prior case series of PNS for HSP 21 , though no differences were found between groups in a RCT comparing PNS to a shoulder sling. 22 The changes that occurred within the study are of smaller magnitude than both the conservative estimate for the MCID of 10 points, 24 and the less stringent estimate of 4.25 points. 25 …”

Section: Discussionmentioning

confidence: 85%

The Effect of Peripheral Nerve Stimulation on Shoulder Biomechanics

Wilson

Knutson

Bennett

et al. 2017

American Journal of Physical Medicine &Amp; Rehabilitation

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Objective To establish the effects on shoulder biomechanics from a peripheral nerve stimulation (PNS) treatment compared to Physical Therapy (PT) in stroke survivors with chronic hemiplegic shoulder pain. Design Single-site, pilot, randomized controlled trial for adults with chronic shoulder pain after stroke. Participants were randomized to receive a 3-week treatment of single-lead PNS or physical therapy (PT). The outcomes included isometric shoulder abduction strength, pain-free shoulder external rotation range of motion (ROM), delay in initiation and termination of shoulder abduction electromyogram (EMG) activity, and the Fugl-Meyer Motor Assessment (upper extremity section). Outcomes were measured at baseline, and at weeks 1, 4, 12, and 16. Results Twenty-five participants were recruited, 13 to PNS and 12 to PT. There were significant improvements for both PNS and PT in maximum isometric shoulder abduction strength, pain-free external rotation ROM, and Fugl-Meyer Motor Assessment. There were no significant changes in delay of initiation or termination of deltoid EMG with either treatment. Conclusions Both PNS and PT are capable of improving shoulder biomechanics in those with HSP, though changes in biomechanics alone do not account for the greater pain relief associated with PNS than PT.

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“…[28] AD’s score increased an additional six points at retention testing. A substantial portion of the 18-point increase occurred in the hand subsection of the UEFMA with an increase of five points (of a possible 14) recorded during the intervention and an additional three point improvement (total increase = 8) recorded at retention.…”

Section: Resultsmentioning

confidence: 99%

Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study

Fluet

Patel

Qiu

et al. 2016

Disability and Rehabilitation

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Purpose The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated. Methods This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl–Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation. Results Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. Conclusion This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes.

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Estimating the Minimal Clinically Important Difference of an Upper Extremity Recovery Measure in Subacute Stroke Patients

Cited by 172 publications

References 20 publications

Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation

Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation

The Effect of Peripheral Nerve Stimulation on Shoulder Biomechanics

Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study

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