The Accuracy of the PREP2 Prediction Tool for Upper Limb Outcomes After Stroke as Part of Routine Clinical Care.
Harry Jordan, Olivia Norrie, Cathy M Stinear
PMID 41574464WHAT IT FOUND
PREP2 predictions by clinicians missed the 70% accuracy target overall.
It worked well for patients with a SAFE score of 5 or higher and those with no motor response to stimulation. Accuracy was poor for those needing stimulation who showed a motor response.
Key findings
01Overall accuracy of PREP2 predictions made by clinicians was 66%, failing to meet the pre-specified 70% threshold for validation in routine care.
02Predictions were highly accurate for patients with a SAFE score of 5 or higher (78%) and for those classified as MEP-negative (100% for Poor outcomes), but poorly accurate for those classified as MEP-positive and predicted to have a Good outcome (27%).
03For MEP-positive patients predicted to have a Good outcome, finger extension strength at day 3 was a strong discriminator: all 7 patients with any finger extension had a favorable outcome, compared to only 2 of 14 with no finger extension.
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
Outcome assessors were not blinded to the PREP2 predictions, which could introduce bias. The sample size for the exploratory analysis of MEP-positive patients was very small (21 participants). TMS equipment and MEP definition criteria differed from those used in the original PREP2 development study, which may affect comparability. Only 2 patients were predicted to have a Limited outcome, so accuracy for this category could not be meaningfully assessed.
Declared interests
The authors declared no conflicts of interest. Funding was provided by the Neurological Foundation of New Zealand for one author's fellowship.
The easy way to misread this
Do not interpret the 66% overall accuracy as uniform reliability. The tool is highly accurate for predicting poor outcomes and for patients with higher initial strength, but it frequently overestimates recovery in MEP-positive patients predicted to have a 'Good' outcome.
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