MEP Status is Not Predictive of Response to Upper Limb Training in People With Chronic, Moderate-Severe Hemiparesis Post-Stroke.
Erin C King, Michael Trevarrow, Sebastian Urday and 3 others
PMID 40130687WHAT IT FOUND
In chronic moderate-to-severe stroke, a motor evoked potential before upper limb training did not predict arm improvement.
People with and without a baseline MEP improved similarly, with similar proportions achieving a 6-point improvement. MEP status alone did not help predict response.
Key findings
01Baseline MEP status had almost no relationship with Fugl-Meyer upper limb change after training; mean change was 5.09 points for MEP+ and 5.05 points for MEP−.
02Similar proportions of MEP+ and MEP− participants achieved a clinically meaningful 6-point Fugl-Meyer improvement: 45% and 47%.
03Adding baseline MEP status to treatment-effect models did not predict outcomes; coefficients were near zero and standard errors increased.
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, retrospective analysis of a randomized trial, not a new trial designed to test MEP status as the primary question. The sample was restricted to adults at least 6 months after unilateral stroke with moderate-to-severe upper limb impairment (Fugl-Meyer Upper Extremity 23 to 40), Modified Ashworth Scale 3 or less, and no cognitive screen below 21. Only 73 of 76 recruited participants were analysed, and 5 of 73 post-treatment Fugl-Meyer scores were missing and handled with imputation. MEP+ and MEP− groups differed at baseline in arm impairment, with mean Fugl-Meyer scores 31.45 and 26.88. The original trial found no significant difference between bilateral motor priming and sham priming, so this analysis cannot attribute improvement to any single component. The authors note that MEP status may not capture corticospinal tract structural integrity, and chronic-phase evidence for MEP as a predictor is limited. The trial took place at a university and rehabilitation hospital, so findings may not generalize to other settings.
Declared interests
The authors declared no conflicts of interest and had nothing to disclose.
The easy way to misread this
Do not conclude that an absent motor evoked potential means poor recovery. MEP-negative participants improved similarly in this trial, but the finding applies to this specific chronic stroke upper limb training protocol in a selected moderate-to-severe sample.