Indirect causal path from motor function to quality of life through daily use of the affected arm poststroke after task-specific training: a longitudinal mediation analysis

Abstract

Purpose

Task-specific training generally targets motor function, with the ultimate goal of improving quality of life (QoL). This study aimed to determine whether motor function indirectly affects QoL through daily use of the affected arm and activities of daily living (ADL) in patients with chronic stroke.

Methods

This was a retrospective cohort study of 155 patients who received training for 90–120 min/session, 3–5 sessions/week, for 4–6 weeks. The training involved specific mirror or robot-assisted therapy, followed by functional task practice for 15–30 min in each session. Patients were assessed before and after the intervention.

Results

At both pre-test and post-test, significant indirect effects of motor function on QoL through daily use of the affect arm and ADL were observed (β = 0.087–0.124). When the change scores of the measures between the pre-test and post-test were used, significant mediating effects of daily arm use on the relationship between motor function and QoL were identified (β = 0.094–0.103).

Conclusions

Enhanced motor function after intervention may lead to an increase in arm use for daily activities and subsequently result in an improvement in QoL. These results highlight the critical role of daily arm use in task-specific training aimed at improving QoL.

IMPLICATIONS FOR REHABILITATION

• Task-specific training may improve motor function, daily arm use, activities of daily living, and quality of life in patients with mild-to-moderate arm hemiparesis.

• To improve quality of life in task-specific training, clinicians may work in sequence from motor function to daily arm use and then to activities of daily living.

• Emphasizing the use of the affected arm in daily life is critical to improve quality of life in task-specific training.

Keywords:

• Physical functional performance
• quality of life
• rehabilitation
• stroke
• upper extremity

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data sets analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study was supported by Chang Gung Memorial Hospital [CMRPD1M0041, CMRPD1M0042, BMRP553], Healthy Aging Research Center, Chang Gung University from the Featured Areas Research Center Program within the Framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan [EMRPD1M0411], the Ministry of Science and Technology [MOST109-2314-B-182-027-MY3, 111-2314-B-182-037-MY3] in Taiwan, and the National Health Research Institutes [NHRI-EX112-11105PI] in Taiwan.