Can stroke survivors with severe upper arm disability achieve a clinically important change in arm function during inpatient rehabilitation? A multicentre, prospective, observational study

Article type: Research Article

Authors: Hayward, Kathryn S.^a | Kuys, Suzanne S.^b | Barker, Ruth N.^{c; d} | Brauer, Sandra G.^{a; *}

Affiliations: [a] Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia | [b] Griffith Health Institute, Griffith University, Gold Coast, Australia; and Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia | [c] Discipline of Physiotherapy, School of Public Health Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD, Australia | [d] Community Rehab Northern Queensland, Townsville Mackay Medicare Local, Townsville, QLD, Australia

Correspondence: [*] Address for correspondence: Sandra G. Brauer, Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane 4072, QLD, Australia. Tel.: +61 7 3365 2275; Fax: +61 7 3365 1622; E-mail: s.brauer@uq.edu.au

Abstract: Background:Severe arm disability is considered to indicate poor potential to recover arm function. Objective:Determine if stroke survivors with severe upper arm disability can achieve a clinically important change in arm function on discharge from inpatient rehabilitation. Methods:618 stroke survivors from 16 inpatient rehabilitation units were assessed on admission and discharge using the Motor Assessment Scale Item 6 Upper Arm Function (MAS6). Admission scores defined participants with severe (MAS6 ≤2) and mild/moderate (MAS6 >2) upper arm disability. A clinically important change was evaluated according to: 1) statistical significance; 2) minimal clinical importance difference (MCID); and 3) shift in disability status i.e., severe to mild/moderate. Achievers of a MCID and shift were compared to non-achievers. Results:Stroke survivors with severe upper arm disability (n = 226) demonstrated a significant improvement in arm function (p < 0.001) at discharge. A MCID was achieved by 68% (n = 155) and a shift from severe to mild/moderate upper arm disability on discharge by 45% (n = 102) of participants. Achievers had a significantly shorter interval from stroke onset to inpatient rehabilitation admission (p < 0.002). Conclusion:Stroke survivors with severe upper arm disability can achieve a clinically important change during inpatient rehabilitation.

Keywords: Stroke, inpatient rehabilitation, functional recovery, severe, motor

DOI: 10.3233/NRE-141096

Journal: NeuroRehabilitation, vol. 35, no. 1, pp. 17-23, 2014