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Prediction of Upper Limb Recovery, General Disability, and Rehabilitation Status by Activity Measurements Assessed by Accelerometers or the Fugl-Meyer Score in Acute Stroke

Gebruers, Nick PT, PhD; Truijen, Steven MSc, PhD; Engelborghs, Sebastiaan MD, PhD; De Deyn, Peter P. MD, PhD

American Journal of Physical Medicine & Rehabilitation: March 2014 - Volume 93 - Issue 3 - p 245–252
doi: 10.1097/PHM.0000000000000045
Original Research Articles

Objective This study investigated the clinical predictive value of the Fugl-Meyer Assessment (FMA) arm score and the upper limb activity assessed by accelerometers in patients with hemiparesis after acute stroke.

Design The prospective cohort (n = 129) was recruited from a general hospital; activity variables and FMA score at intake were related to the FMA, the modified Rankin Scale, and rehabilitation status after 3 mos of follow-up. The prediction model was based on binary logistic regression.

Results Although the FMA score at intake has the best overall predictive value for all three outcome measures (FMA3, 87.6%; modified Rankin Scale, 85.3%; RS, 73.6%), the activity of the impaired arm as assessed by the accelerometer has the best predictive value to determine patients who are at risk for continued disability (modified Rankin Scale score 1, 95.1%). The most difficult outcome measure for prediction is the rehabilitation status; specifically, the patients who went home are predicted imprecisely. The ratio variable is the least accurate predictor of all tested variables.

Conclusions The FMA arm score at intake is the best predictor for arm recovery and general disability. The activity of the impaired arm is an excellent predictor for prolonged disability and is an alternative to the FMA score when it is impossible to score the FMA in the acute phase of stroke.

From the Department of Health Care Sciences, ARTESIS University College of Antwerp, Antwerp, Belgium (NG, ST, PPDD); Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim, Antwerp, Belgium (SE); Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge (SE, PPDD), and Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences (NG, ST), University of Antwerp, Antwerp, Belgium; and Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands (PPDD).

All correspondence and requests for reprints should be addressed to: Nick Gebruers, PT, PhD, University of Antwerp, Universiteitsplein 1, BE-2610 Antwerp, Belgium.

Supported by the Artesis Hogeschool Antwerpen, Belgium (grant no. G817).

Presented at the European Stroke Conference 2012 and the ESC 2013 in Lisbon and London, respectively (preliminary results).

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2014 by Lippincott Williams & Wilkins