Match and mismatch between objective and subjective improvements in upper limb function after stroke

Abstract

Purpose: To identify stroke patients showing a match between an objectively meaningful improvement in upper-limb motor capacity and subjectively meaningful improvement in upper-limb performance after stroke, as well as determinants of matching and non-matching. Methods: Changes in upper-limb capacity in 39 stroke patients were measured over 17 weeks using the Action Research Arm Test (ARAT). Subjective change was measured with the Stroke Impact Scale Hand domain (SIS-Hand) and the Motor Activity Log (MAL). Patients showing a match between objective and subjective improvements (matchers) and patients showing a mismatch (non-matchers) were identified. Subsequently, determinants for the matchers were modeled using a logistic regression analysis. Results: A significant association was found between improvements on the ARAT and MAL (p = 0.011), but not for improvements on the ARAT and SIS-Hand. For the ARAT and SIS-Hand level of education and mood significantly improved the model. The probability of a match between objective and subjective outcomes in lower-educated patients with a positive mood was estimated to be 0.83, whereas in higher-educated patients with a negative mood it was estimated to be 0.07. Conclusions: Mismatches between objective and subjective outcomes are relevant for practitioners evaluating rehabilitation goals, and for defining outcome variables in future upper limb rehabilitation trials.

Implications for Rehabilitation

• In upper limb rehabilitation after stroke, a match between capacity and self-perception outcome measures is not self-evident.

• Regarding these potential mismatches, practitioners and patients should consider carefully which goals to set, and how to evaluate upper limb rehabilitation after stroke; preferably with capacity measures and self-perception measures combined.

• Minimal Clinically Important Difference
• outcome measure
• stroke
• upper limb function