Abstract
Objectives
Investigate upper limb (UL) capacity and performance from <14-days to 24-months post stroke.
Design
Longitudinal study of participants with acute stroke, assessed ≤14-days, 6-weeks, 3-, 6-, 12-, 18-, and 24-months post stroke.
Setting
Two acute stroke units.
Main outcome measures
Examination of UL capacity using Chedoke McMaster Stroke Assessment (combined arm and hand scores, 0–14), performance using Motor Activity Log (amount of movement and quality of movement, scored 0–5), and grip strength (kg) using Jamar dynamometer. Random effects regression models were performed to explore the change in outcomes at each time point. Routine clinical imaging was used to describe stroke location as cortical, subcortical or mixed.
Results
Thirty-four participants were enrolled: median age 67.7 years (IQR 60.7–76.2), NIHSS 11.5 (IQR 8.5–16), female n = 10 (36%). The monthly rate of change for all measures was consistently greatest in the 6-weeks post baseline. On average, significant improvements were observed to 12-months in amount of use (median improvement 1.81, 95% CI 1.35 to 2.27) and strength (median improvement 8.29, 95% CI 5.90 to 10.67); while motor capacity (median improvement 4.70, 95% CI 3.8 to 5.6) and quality of movement (median improvement 1.83, 95% CI 1.37 to 2.3) improved to 18-months post stroke. Some individuals were still demonstrating gains at 24-months post stroke within each stroke location group.
Conclusion
This study highlights that the greatest rate of improvement of UL capacity and performance occurs early post stroke. At the group level, improvements were evident at 12- to 18-months post stroke, but at the individual level improvements were observed at 24-months.
Clinical trial registration
ACTRN12612000123842.
Abbreviations:
CI (confidence interval), CT (computed tomography), IQR (interquartile range), MAL (Motor Activity Log), MRI (magnetic resonance imaging), NIHSS (National Institutes of Health Stroke Scale), UL (upper limb)
Citation
Recovery of upper limb function is greatest early after stroke but does continue to improve during the chronic phase: a two-year, observational study