Breaking Proportional Recovery After Stroke.
Merav R Senesh, David J Reinkensmeyer
PMID 31416391WHAT IT FOUND
Stroke arm recovery that looks proportional is partly a score artifact.
Rule-breaking patients mostly fail wrist, hand, shoulder, and finger-to-nose items. Mid-range chronic scorers improved more in published arm practice trials.
Key findings
01The proportional recovery rule can arise from the way summed test scores are built and analyzed, and the local slope in real Fugl-Meyer data was not constant.
02Patients with chronic Fugl-Meyer scores below 40, identified as non-fitters, had the lowest chance of passing items that require coordinated wrist and hand movement, shoulder flexion without bending the elbow, and fast finger-to-nose movement.
03In reanalyses of published movement-practice studies, chronic stroke patients with baseline Fugl-Meyer scores of 22 to 40 showed significantly greater reported improvement than patients in the other baseline score groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a secondary analysis and simulation study, not a new treatment trial, so it cannot prove that intensive movement practice caused the larger improvement in the 22 to 40 group. The rehabilitation finding assumes that chronic patients with Fugl-Meyer scores below 40 would have been non-fitters if followed from the acute phase; the authors say this assumption should be verified. The original proportional-recovery samples were highly selected, and only 7% of consecutive stroke inpatients met the criteria, so the results may not apply to many patients with severe cognitive, communication, vision, neglect, sensory, mobility, or recurrent/hemorrhagic stroke. The better-recovered non-fitters were a small subgroup, about 12% of all stroke patients in the analyzed proportional-recovery data and 45% of non-fitters. The usual global linear regression for detecting proportional recovery can miss local changes in slope, and noisy data or limited sample size make this hard to correct. The Fugl-Meyer measures impairment rather than hand function; the hand-dexterity inference relied on published relationships with the Box and Blocks Test.
Declared interests
The authors declared no conflict of interest. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not read the larger improvement in patients with chronic Fugl-Meyer scores of 22 to 40 as proof that intensive movement practice works for all non-fitters. It comes from reanalysis of published trials that included different kinds of movement practice, assumes these patients would have been non-fitters in the acute phase, and the group was small.