Defining Severity Levels for Post-Stroke Upper Limb Motor Impairment and Activity Limitation: A Systematic Review.
Elena Ierardi, Frederike van Wijck, Myzoon Ali and 2 others
PMID 41665473WHAT IT FOUND
Current clinical language for post-stroke arm severity is inconsistent.
Most studies use 'mild, moderate, severe' but define these terms differently, and cut-off scores on common tests like the Fugl-Meyer overlap significantly. This makes it difficult to compare patients or trials.
Key findings
01The most common descriptors for upper limb severity are 'mild', 'moderate', and 'severe', used in 77% of the included papers.
02There is considerable overlap in the Fugl-Meyer Upper Extremity (FMA-UE) score ranges used to define severe, moderate, and mild impairment, making clear boundaries difficult to establish.
03Only 8% of the included studies provided enough data to statistically analyze severity cut-offs using the top three recommended outcome measures.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review only included English-language publications, which may exclude relevant studies from other regions. The sample of analyzed studies was skewed: only 2% of participants were in the late sub-acute stage, and only 2% were described as having mild severity, limiting generalizability to these groups. Statistical analysis was restricted to a small subset (8%) of the included papers that met the highest precision criteria. The review synthesized group-level data from published studies rather than individual patient data, which limits the ability to refine cut-offs precisely.
Declared interests
The authors declare no potential conflicts of interest. One author received a PhD studentship from Glasgow Caledonian University, but the authors state no other financial support was received for the research or publication.
The easy way to misread this
Do not assume that the FMA-UE cut-offs identified in this review (e.g., 0-25 for severe) are validated standards for clinical practice. The review highlights that these boundaries are heterogeneous and overlapping across studies, indicating a lack of consensus rather than a new definitive classification.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →