Mismatch between observed and perceived upper limb function: an eye-catching phenomenon after stroke

Abstract

Purpose: To investigate the relation between observed and perceived upper limb motor function in patients with chronic stroke.

Material and methods: We investigated 32 patients at six months after stroke with the Fugl-Meyer Assessment (observed function) and hand subscale of the Stroke Impact Scale (perceived function). Spearman correlation was calculated to relate observed and perceived function. Through cut-off scores, we divided our sample in low (Fugl-Meyer Assessment <31/66) and good observed function, and low (hand subscale of Stroke Impact Scale <61/100) and good perceived function. Scatterplot and hierarchical clustering analysis was conducted to detect distinct groups.

Results: A strong positive relation was found between observed and perceived function (r = 0.84). Three groups could be identified; a “low match group” of patients with low observed and low perceived function (n = 11, 34%), a “good match group” containing patients with good observed and good perceived function (n = 15, 47%), and a “mismatch group” comprising patients with good observed but low perceived function (n = 6, 19%).

Conclusions: In our chronic sample, one in five patients showed good upper limb observed but low perceived function. Measuring both observed and perceived arm and hand function seems warranted together with considering a differential therapy approach for the distinct groups.

Implications for rehabilitation

• A considerable group of patients in the chronic phase post-stroke have good motor function in their affected upper limb, but nevertheless perceive a restricted ability.

• In order to identify a mismatch in people with chronic stroke, both observed and perceived upper limb motor function should be assessed.

• Besides common measurement tools for observed function like the Fugl-Meyer Assessment, perceived function can be evaluated by means of the hand function section of the Stroke Impact Scale.

• For patients with good observed but low perceived function, an additional rehabilitation strategy should be considered, potentially including awareness of ability and a self-efficacy approach.

Keywords:

• Stroke
• upper limb function
• observed function
• perceived function
• objective outcome
• subjective outcome

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Promobilia Foundation Sweden under Grant number [15060]; and the Foundation Van Goethem-Brichant, Belgium.