Responsiveness and trajectory of changes in the rating of everyday arm-use in the community and home (REACH) scale over the first-year post-stroke.
Lisa A Simpson, Kathryn S Hayward, Lara A Boyd and 5 others
PMID 36310441WHAT IT FOUND
About 87% of participants used their affected arm more by 12 months, with the biggest gains by three months.
People with severe baseline arm weakness started lower and improved differently. Arm-use scores changed with arm capacity and self-reported change.
Key findings
01About 87% of participants improved their REACH score by 12 months, and the largest improvement occurred between baseline and three months.
02Average REACH scores were higher in the mild/moderate impairment group at all time points, and early change differed by impairment, but the change difference at 12 months was not significant.
03Four of six responsiveness hypotheses were supported: change in REACH correlated with capacity and self-reported change, but correlations with impairment and accelerometer counts were weaker than 0.4.
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 was an observational measurement study with no control group and no assigned treatment, so it cannot show that therapy caused the changes in REACH scores. The sample was 73 participants, and the study was described as hypothesis-generating, so the responsiveness evidence is preliminary. Data were missing: 234 of 292 REACH values were obtained, and retention fell to 64.4% by 12 months. Participants with left-sided weakness were more likely to have missing data after the three-month visit. Some participants were enrolled later than intended, with baseline visits from 3 to 50 days post-stroke. Baseline arm use was self-report, and the authors suggest some participants may have overestimated it early after stroke. Two different accelerometer systems were used, which may have affected comparisons between REACH change and activity counts. Cognitive screening was not used as an inclusion criterion, which could affect relationships between self-reported use and other measures.
Declared interests
The authors declared no potential conflicts of interest. Funding came from Canadian Institutes of Health Research Foundation Grant and Project Grant (grant numbers FDN 143340 and PJT-153330).
The easy way to misread this
Do not read the early improvement as proof that rehabilitation caused it. This was an observational study with no control group, and some participants decreased their REACH level between six and 12 months.