Proportional Recovery After Stroke: Addressing Concerns Regarding Mathematical Coupling and Ceiling Effects.
Benjamin Chong, Alan Wang, Cathy M Stinear
PMID 37269116WHAT IT FOUND
Stroke recovery is not just a measurement problem, according to this review.
Baseline upper limb impairment still predicts how much function returns, but the Fugl-Meyer scale cannot measure recovery above its top score.
Key findings
01Proportional recovery is presented as a valid group-level model for spontaneous recovery after stroke, not as a finding invalidated by mathematical coupling or ceiling effects.
02The Fugl-Meyer Upper Extremity ceiling is described as a limitation of the scale, not of proportional recovery.
03Measurement error in baseline scores can make proportional recovery correlations look stronger, but the effect is small unless baseline error variance is large.
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
This is a methodological review and simulation, not a new treatment trial, so it does not tell you what will happen to a patient. The main examples use the Fugl-Meyer Upper Extremity scale, whose ceiling can hide impairment. Biomarker findings mostly apply to upper limb motor recovery, not to aphasia, neglect, or other outcomes. The conclusions depend on the authors' chosen statistical models and assumptions, not on direct patient data.
Declared interests
The authors declared no potential conflicts of interest. The work was partially supported by the Health Research Council of New Zealand.
The easy way to misread this
Do not read proportional recovery as proof that a patient will recover a fixed amount or that baseline severity alone explains recovery. It is a group pattern, and some patients recover more than expected while others recover less.