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European Journal of Physical and Rehabilitation Medicine 2020 Jul 15

DOI: 10.23736/S1973-9087.20.06311-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Predictive factors of upper limb motor recovery for stroke survivors admitted to a rehabilitation programme

Jingyi WU 1, 2, Jiaqi ZHANG 3, Zhongfei BAI 3,4, Song CHEN 1 ,2, Sufang CAI 1, 2

1 Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China; 2 Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China; 3 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; 4 Department of Occupational Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China


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BACKGROUND: Various factors may interact with functional gains from upper limb motor training in patients with stroke.
AIM: This study aimed to explore the predictors of upper limb motor recovery in patients with stroke who were admitted to a rehabilitation programme.
DESIGN: A retrospective, longitudinal observational study was conducted to evaluate the change in Fugl-Meyer assessment upper extremity score (FMA-UE) at admission and 15 and 30 days after admission.
SETTING: A rehabilitation hospital.
POPULATION: Patients received rehabilitation training during the study period.
METHODS: Demographic information and clinical factors were collected as independent variables. Longitudinal analysis of UE motor recovery measured by FMAUE over time was performed using the mixed-effects model.
RESULTS: Data from 110 participants were included. FMA-UE score showed significant increase (β = 4.12, P < 0.001). Cognitive functions assessed by the Montreal Cognitive Assessment (MoCA) positively correlated with the improvement in UE functions (β = 0.13, P < 0.001), while time since stroke negatively correlated with improvement across time (β = -0.05, P = 0.019). Patients with subcortical lesions improved faster than those with mixed cortical and subcortical lesions did (difference in slope = 2.83, P = 0.001). Improvement in patients with moderately impaired UE motor functions was faster than in those with severely impaired UE motor functions (difference in slope = 2.74, P = 0.016). Severity of hemiplegia, MoCA, and time since stroke were significant predictors in multivariable, mixed-effects models.
CONCLUSIONS: Initial motor and cognitive impairments may be associated with UE motor recovery in patients admitted to a rehabilitation programme.
CLINICAL REHABILITATION IMPACT: Early assessments of motor and cognitive impairments after stroke would contribute to the prediction of UE motor recovery in patients admitted to a rehabilitation programme. The information would also help the stratification of patients for poststroke upper limb rehabilitation trials.


KEY WORDS: Stroke; Upper limb; Motor impairment; Mixed-effects model

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