Article

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.

Langue : ANGLAIS