Long-term recovery of upper limb motor function and self-reported health: results from a multicenter observational study 1 year after discharge from rehabilitation

Neurological Research and Practice - 2021
Thies Ingwersen1, Silke Wolf1, G Birke1, Eckhard Schlemm1, Christian Bartling2, Gabriele Bender3, Alfons Meyer2, Achim Nolte4, Katharina Ottes3, Oliver Pade5, M. Peller6, J. Steinmetz5, Christian Gerloff1, Götz Thomalla1
1Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
2MediClin Klinikum Soltau, Oeninger Weg 59, 29614, Soltau, Germany
3RehaCentrum Hamburg GmbH, Martinistraße 66, 20246, Hamburg, Germany
4VAMED Klinik Geesthacht, Johannes-Ritter-Straße 100, 21502, Geesthacht, Germany
5Klinikum Bad Bramstedt, Klinik Für Neurologische Rehabilitation, Oskar-Alexander-Straße 26, 24576, Bad Bramstedt, Germany
6VAMED Rehaklinik Damp, Seute-Deern-Ring 30, 24351, Damp, Germany

Tóm tắt

AbstractBackgroundImpaired motor functions after stroke are common and negatively affect patients' activities of daily living and quality of life. In particular, hand motor function is essential for daily activities, but often returns slowly and incompletely after stroke. However, few data are available on the long-term dynamics of motor recovery and self-reported health status after stroke. The Interdisciplinary Platform for Rehabilitation Research and Innovative Care of Stroke Patients (IMPROVE) project aims to address this knowledge gap by studying the clinical course of recovery after inpatient rehabilitation.MethodsIn this prospective observational longitudinal multicenter study, patients were included towards the end of inpatient rehabilitation after ischemic or hemorrhagic stroke. Follow-up examination was performed at three, six, and twelve months after enrollment. Motor function was assessed by the Upper Extremity Fugl-Meyer Assessment (FMA), grip and pinch strength, and the nine-hole peg test. In addition, Patient-Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10) was included. Linear mixed effect models were fitted to analyze change over time. To study determinants of hand motor function, patients with impaired hand function at baseline were grouped into improvers and non-improvers according to hand motor function after twelve months.ResultsA total of 176 patients were included in the analysis. Improvement in all motor function scores and PROMIS-10 was shown up to 1 year after inpatient rehabilitation. FMA scores improved by an estimate of 5.0 (3.7–6.4) points per year. In addition, patient-reported outcome measures increased by 2.5 (1.4–3.6) and 2.4 (1.4–3.4) per year in the physical and mental domain of PROMIS-10. In the subgroup analysis non-improvers showed to be more often female (15% vs. 55%,p = 0.0155) and scored lower in the Montreal Cognitive Assessment (25 [23–27] vs. 22 [20.5–24],p = 0.0252).ConclusionsContinuous improvement in motor function and self-reported health status is observed up to 1 year after inpatient stroke rehabilitation. Demographic and clinical parameters associated with these improvements need further investigation. These results may contribute to the further development of the post-inpatient phase of stroke rehabilitation.Trial registration: The trial is registered at ClinicalTrials.gov (NCT04119479).

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