Impairments of the arm and hand are highly correlated during subacute stroke.
Lydia N Reid, Sean P Dukelow, Stephen H Scott
PMID 37219403WHAT IT FOUND
Arm and hand impairments in subacute stroke are highly correlated, with most patients scoring within one point of each other on clinical scales.
Clinicians should not assume the hand is worse than the arm; assessing one segment often provides sufficient information about the other.
Key findings
01Rank correlation between arm and hand impairment scores was strong (0.79 early, 0.75 late), and 88% of participants had scores within one point of each other in the early phase.
02Clinical assessments showed a ceiling effect, with 58% of participants scoring the maximum value for the arm and 45% for the hand in the late subacute phase, limiting the ability to distinguish subtle recovery differences.
03When discrepancies occurred, they were more likely to show greater impairment in the arm than the hand, challenging the traditional view that distal (hand) function is always more affected than proximal (arm) function.
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
The study used a convenience sample from two hospitals, which may not represent all stroke populations. The CMSA had a significant ceiling effect in the late subacute phase, making it difficult to distinguish between patients with mild residual deficits and those who had fully recovered. The Purdue Pegboard had a floor effect in the early phase, failing to capture variability in patients with severe impairment. The study was observational and did not test an intervention, so it describes patterns of impairment rather than treatment outcomes.
Declared interests
The authors declare no conflicts of interest. The study was supported by the Canadian Institutes of Health Research and the Heart & Stroke Foundation.
The easy way to misread this
Do not assume that a high CMSA score indicates full functional recovery. The study showed a ceiling effect on the CMSA, where many patients scored 7 despite still having measurable impairments on the more sensitive robotic reaching task.