Predictors of upper limb recovery after stroke: a systematic review and meta-analysis

Objective: To systematically review and summarize the current available literature on prognostic variables relating to upper limb recovery following stroke. To identify which, if any variables predict upper limb recovery following stroke. Data sources: We completed searches in MEDLINE, EMBASE, AMED, CINAHL and Cochrane CENTRAL databases. Searches were completed in November 2010. Review methods: Studies were included if predictor variables were measured at baseline and linked to an outcome of upper limb recovery at a future time point. Exclusion criteria included predictor variables relating to response to treatment and outcome measurements of very specific upper limb impairments such as spasticity or pain. Two independent reviewers completed data extraction and assessed study quality. Results: Fifty-eight studies met the inclusion criteria. Predictor variables which have been considered within these studies include; age, sex, lesion site, initial motor impairment, motor-evoked potentials andsomatosensory-evoked potentials. Initial measures of upper limb impairment and function were found to be the most significant predictors of upper limb recovery; odds ratio 14.84 (95% confidence intervals (CI) 9.08–24.25) and 38.62 (95% CI 8.40–177.53), respectively. Conclusions: Interpretation of these results is complicated by methodological factors including variations in study populations, upper limb motor outcome scales, timing of baseline and outcome assessments and predictors selected. The most important predictive factors for upper limb recovery following stroke appears to the initial severity of motor impairment or function.

[1]  C. Wolfe,et al.  The impact of stroke. , 2000, British medical bulletin.

[2]  J. H. van der Lee,et al.  Exercise therapy for arm function in stroke patients: a systematic review of randomized controlled trials , 2001, Clinical rehabilitation.

[3]  P Noël,et al.  Magnetic transcranial stimulation: clinical interest of the silent period in acute and chronic stages of stroke. , 1997, Electroencephalography and clinical neurophysiology.

[4]  R L Hewer,et al.  Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator. , 1989, Journal of neurology, neurosurgery, and psychiatry.

[5]  J. Melvin,et al.  Somatosensory evoked potentials: their predictive value in right hemiplegia. , 1982, Archives of physical medicine and rehabilitation.

[6]  W. Byblow,et al.  Functional potential in chronic stroke patients depends on corticospinal tract integrity. , 2006, Brain : a journal of neurology.

[7]  A. Nascimbeni,et al.  Motor evoked potentials: prognostic value in motor recovery after stroke. , 2006, Functional neurology.

[8]  Prediction of motor function by magnetic brain stimulation in patients with intracerebral hematoma. , 1992, Neurologia medico-chirurgica.

[9]  A. Geurts,et al.  Predicting Hand Motor Recovery in Severe Stroke: The Role of Motor Evoked Potentials in Relation to Early Clinical Assessment , 2009, Neurorehabilitation and neural repair.

[10]  François Chollet,et al.  Correlation between cerebral reorganization and motor recovery after subcortical infarcts , 2003, NeuroImage.

[11]  Jill Hayden,et al.  Evaluation of the Quality of Prognosis Studies in Systematic Reviews , 2006, Annals of Internal Medicine.

[12]  R. Rosenfeld.  Patients , 2012, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[13]  Victor De Pasqua,et al.  Post-stroke reorganization of hand motor area: a 1-year prospective follow-up with focal transcranial magnetic stimulation , 2003, Clinical Neurophysiology.

[14]  F. Binkofski,et al.  Recovery of Motor Functions following Hemiparetic Stroke: A Clinical and Magnetic Resonance-Morphometric Study , 2001, Cerebrovascular Diseases.

[15]  L. Rinaldi,et al.  Shoulder subluxation after stroke: relationships with pain and motor recovery. , 2007, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[16]  G. Kwakkel,et al.  Presence of Finger Extension and Shoulder Abduction Within 72 Hours After Stroke Predicts Functional Recovery: Early Prediction of Functional Outcome After Stroke: The EPOS Cohort Study , 2010, Stroke.

[17]  O. Keren,et al.  Dynamic changes in upper limb short latency somatosensory-evoked potentials following stroke in the dominant hemisphere , 1995 .

[18]  Joanne M Wagner,et al.  Sensorimotor Impairments and Reaching Performance in Subjects With Poststroke Hemiparesis During the First Few Months of Recovery , 2007, Physical Therapy.

[19]  Cindy Farquhar,et al.  3 The Cochrane Library , 1996 .

[20]  David Moher,et al.  Meta-analysis of Observational Studies in Epidemiology , 2000 .

[21]  C. Winstein,et al.  The EXCITE Trial: Predicting a Clinically Meaningful Motor Activity Log Outcome , 2008, Neurorehabilitation and neural repair.

[22]  D. Wade,et al.  Loss of arm function after stroke: measurement, frequency, and recovery. , 1986, International rehabilitation medicine.

[23]  N B Lincoln,et al.  Prediction of arm and hand function recovery in stroke patients , 1987, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[24]  M. Escudero,et al.  Prognostic value of motor evoked potential obtained by transcranial magnetic brain stimulation in motor function recovery in patients with acute ischemic stroke. , 1998, Stroke.

[25]  H. Ring,et al.  Upper Limb Somatosensory Evoked Potentials as a Predictor of Rehabilitation Progress in Dominant Hemisphere Stroke Patients , 1993, Stroke.

[26]  I. Olkin,et al.  Meta-analysis of observational studies in epidemiology - A proposal for reporting , 2000 .

[27]  P J Delwaide,et al.  Ipsilateral Motor Responses to Focal Transcranial Magnetic Stimulation in Healthy Subjects and Acute-Stroke Patients , 2001, Stroke.

[28]  M. Sands,et al.  The effect of shoulder pain on outcome of acute hemiplegia , 1995 .

[29]  Y. Hsieh,et al.  Potential Predictors of Motor and Functional Outcomes After Distributed Constraint-Induced Therapy for Patients With Stroke , 2009, Neurorehabilitation and neural repair.

[30]  B Dan,et al.  Facilitation of motor evoked potentials in ischemic stroke patients: prognostic value and neurophysiologic correlations , 2003, Clinical Neurophysiology.

[31]  Nicola Smania,et al.  Active Finger Extension: A Simple Movement Predicting Recovery of Arm Function in Patients With Acute Stroke , 2007, Stroke.

[32]  L. Ada,et al.  Loss of strength contributes more to physical disability after stroke than loss of dexterity , 2004, Clinical rehabilitation.

[33]  Douglas G Altman,et al.  Systematic reviews of evaluations of prognostic variables , 2001, BMJ : British Medical Journal.

[34]  S. Miller,et al.  Longitudinal study of central motor conduction time following stroke. 1. Natural history of central motor conduction. , 1993, Brain : a journal of neurology.

[35]  J. Krakauer,et al.  Neurorehabilitation and Neural Repair Inter-individual Variability in the Capacity for Motor Recovery after Ischemic Stroke Neurorehabilitation and Neural Repair Additional Services and Information for Inter-individual Variability in the Capacity for Motor Recovery after Ischemic Stroke , 2022 .

[36]  A. Pizzi,et al.  Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke. , 2009, Journal of rehabilitation medicine.

[37]  P. Easterbrook,et al.  Publication bias in clinical research , 1991, The Lancet.

[38]  Robert West,et al.  About The Cochrane Collaboration (Cochrane Review Groups (CRGs)). , 2011 .

[39]  I. Miyai,et al.  Proximal paresis of the upper extremity in patients with stroke , 2007, Neurology.

[40]  Nancy E Mayo,et al.  Upper-limb function and recovery in the acute phase poststroke. , 2005, Journal of rehabilitation research and development.

[41]  O. Hardiman,et al.  Recovery of the upper limb post ischaemic stroke and the predictive value of the Orpington Prognostic Score , 2004, Clinical rehabilitation.

[42]  P. Delwaide,et al.  Can motor recovery in stroke patients be predicted by early transcranial magnetic stimulation? , 1996, Stroke.

[43]  C. Gowland,et al.  Recovery of motor function following stroke: Profile and predictors , 1982 .

[44]  Koen Putman,et al.  Effect of socioeconomic status on functional and motor recovery after stroke: a European multicentre study , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[45]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[46]  B. Volpe,et al.  Motor Impairment as a Predictor of Functional Recovery and Guide to Rehabilitation Treatment After Stroke , 2001, Neurorehabilitation and neural repair.

[47]  F. Hamdan,et al.  Somatosensory evoked potentials as a predictor for functional recovery of the upper limb in patients with stroke. , 2009, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[48]  E. Hendriks,et al.  Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies , 2003, Pain.

[49]  S. Miller,et al.  Longitudinal study of central motor conduction time following stroke. 2. Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months. , 1993, Brain : a journal of neurology.

[50]  P J Delwaide,et al.  Absence of response to early transcranial magnetic stimulation in ischemic stroke patients: prognostic value for hand motor recovery. , 1999, Stroke.

[51]  M. Rabadi,et al.  Comparison of the action research arm test and the Fugl-Meyer assessment as measures of upper-extremity motor weakness after stroke. , 2006, Archives of physical medicine and rehabilitation.

[52]  T. Olsen,et al.  Epidemiology of stroke-related disability. , 1999, Clinics in geriatric medicine.

[53]  C. Stinear,et al.  Prediction of recovery of motor function after stroke , 2010, The Lancet Neurology.

[54]  La Joie Wj,et al.  Somatosensory evoked potentials: their predictive value in right hemiplegia. , 1982 .

[55]  J. van Limbeek,et al.  Prediction of recovery from upper extremity paralysis after stroke by measuring evoked potentials. , 1997, Scandinavian journal of rehabilitation medicine.

[56]  A. M. Pettersen,et al.  Subjective well-being one year after stroke , 1997, Clinical rehabilitation.

[57]  J. Marshall.  Stroke: A Critical Approach to Diagnosis, Treatment and Management , 1985 .

[58]  Caring for patients with hemiplegia in an arm following a stroke. , 2004, British journal of nursing.

[59]  Shoulder shrug — a prognostic sign for recovery of hand movement after stroke , 1990, The Medical journal of Australia.

[60]  G. Abbruzzese,et al.  Motor recovery following stroke: a transcranial magnetic stimulation study , 2000, Clinical Neurophysiology.

[61]  C. Hui-Chan,et al.  Predicting recovery of dextrous hand function in acute stroke , 2009, Disability and rehabilitation.

[62]  A Cruz Martínez,et al.  Motor hand recovery after stroke. Prognostic yield of early transcranial magnetic stimulation. , 1999, Electromyography and clinical neurophysiology.

[63]  I. Miyai,et al.  Benefit of inpatient multidisciplinary rehabilitation up to 1 year after stroke. , 2003, Archives of physical medicine and rehabilitation.

[64]  Plamen Tzvetanov,et al.  Prognostic value of median and tibial somatosensory evoked potentials in acute stroke , 2005, Neuroscience Letters.

[65]  M. Reding,et al.  Effect of Lesion Location on Upper Limb Motor Recovery After Stroke , 2001, Stroke.

[66]  P. Rothwell,et al.  The high cost of not funding stroke research: a comparison with heart disease and cancer , 2001, The Lancet.

[67]  A. Eagger.  Rehabilitation , 1960 .

[68]  Dae-Shik Kim,et al.  Motor outcome according to the integrity of the corticospinal tract determined by diffusion tensor tractography in the early stage of corona radiata infarct , 2007, Neuroscience Letters.

[69]  T. Olsen,et al.  Arm and leg paresis as outcome predictors in stroke rehabilitation. , 1990, Stroke.

[70]  W De Weerdt,et al.  Predicting motor recovery of the upper limb after stroke rehabilitation: value of a clinical examination. , 2000, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[71]  W De Weerdt,et al.  Predicting arm recovery following stroke: value of site of lesion , 2000, Acta neurologica Scandinavica.

[72]  R L Hewer,et al.  Assessment of recovery of arm control in hemiplegic stroke patients. 1. Arm function tests. , 1980, International rehabilitation medicine.

[73]  R Langton-Hewer,et al.  The hemiplegic arm after stroke: measurement and recovery. , 1983, Journal of neurology, neurosurgery, and psychiatry.

[74]  R. Lyle.  A performance test for assessment of upper limb function in physical rehabilitation treatment and research , 1981, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[75]  S C Loewen,et al.  Predictors of stroke outcome using objective measurement scales. , 1990, Stroke.

[76]  G. Kwakkel,et al.  Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. , 2003, Stroke.

[77]  H. Ducarne,et al.  Magnetic transcranial stimulation in non-haemorrhagic sylvian strokes: interest of facilitation for early functional prognosis. , 1995, Electroencephalography and clinical neurophysiology.

[78]  Mary Elizabeth Parker,et al.  Recovery of Upper Extremity Function in Stroke Patients: The Copenhagen Stroke Study , 1995 .

[79]  M. Zwarts,et al.  Motor Evoked Potentials in Predicting Recovery from Upper Extremity Paralysis after Acute Stroke , 2003, Cerebrovascular Diseases.

[80]  P. Tzvetanov,et al.  Can SSEP results predict functional recovery of stroke patients within the "therapeutic window"? , 2004, Electromyography and clinical neurophysiology.

[81]  Catherine E Lang,et al.  Active range of motion predicts upper extremity function 3 months after stroke. , 2009, Stroke.

[82]  Hilde Feys,et al.  Value of somatosensory and motor evoked potentials in predicting arm recovery after a stroke , 2000, Journal of neurology, neurosurgery, and psychiatry.

[83]  S. Jang,et al.  Comparison of TMS and DTT for predicting motor outcome in intracerebral hemorrhage , 2010, Journal of the Neurological Sciences.

[84]  B. Koes,et al.  Prognostic factors of progression of osteoarthritis of the knee: a systematic review of observational studies. , 2007, Arthritis and rheumatism.

[85]  R N Lemon,et al.  Contralateral and ipsilateral EMG responses to transcranial magnetic stimulation during recovery of arm and hand function after stroke. , 1996, Electroencephalography and clinical neurophysiology.

[86]  吉岡 秀幸.  Diffusion tensor tractography predicts motor functional outcome in patients with spontaneous intracerebral hemorrhage , 2008 .

[87]  Use of the Halstead Category Test as a cognitive predictor of functional recovery in the hemiplegic upper limb: a cross-validation study. , 1999, The Clinical neuropsychologist.

[88]  C. Winstein,et al.  A Systematic Review of Voluntary Arm Recovery in Hemiparetic Stroke: Critical Predictors for Meaningful Outcomes Using the International Classification of Functioning, Disability, and Health , 2009, Journal of neurologic physical therapy : JNPT.

[89]  H. Hummelsheim,et al.  Change of strength and rate of rise of tension relate to functional arm recovery after stroke. , 2009, Archives of physical medicine and rehabilitation.