Volume 43 Number 3, May/June 2006
Pages 401 — 408
Abstract - Relationships between upper-limb functional limitation and self-reported
disability 3 months after stroke
Alexander W. Dromerick, MD;1-3* Catherine E. Lang, PhD, PT;3 Rebecca Birkenmeier, MS, OTR;1
Michele G . Hahn, MS, OTR;2 Shirley A. Sahrmann, PhD, PT;1,3 Dorothy F. Edwards, PhD1-2
1Department of Neurology, and Programs in 2Occupational Therapy and 3Physical Therapy, Washington University, St. Louis, MO
Abstract — This study explored relationships between upper-limb (UL) functional limitations and self-reported disability in stroke patients with relatively pure motor hemiparesis who were enrolled in an acute rehabilitation treatment trial. All participants were enrolled in the VECTORS (Very Early Constraint Treatment for Recovery from Stroke) study. VECTORS is a single-center pilot clinical trial of early application of constraint-induced movement therapy (CIMT). All 39 subjects who completed 90 days of VECTORS were included in this analysis. Trained study personnel who were blinded to the treatment type performed all evaluations. Data in this article examine relationships between assessments performed 90 days after stroke. Functional limitation measures included the Action Research Arm (ARA) test and Wolf Motor Function Test (WMFT), and self-reported disability measures included the Functional Independence Measure (FIM) and Motor Activity Log (MAL) (by telephone). Mean plus or minus standard deviation time from stroke onset to randomization was 9.4 plus or minus 4.3 days, and median time to follow-up was 99 days (range 68-178). Subjects with perfect or near-perfect scores on the ARA test or WMFT reported residual disability on the FIM and MAL. Quality of movement on the WMFT (functional ability score) was not strongly associated with self-reported frequency, and speed of movement on the WMFT (timed score) was not associated with self-reported frequency (MAL amount of use). In this early UL intervention trial, we found that perceived disability measures captured information that was not assessed by functional limitation and impairment scales. Our results indicate that excellent motor recovery as measured by functional limitation and impairment scales did not equal restoration of everyday productive UL use and speed of task completion did not translate to actual use. Our results confirm the need for a measurement strategy that is sensitive to change, assesses a broad performance range, and detects meaningful clinical improvements in early rehabilitation intervention trials.
Key words: activities of daily living, arm, cerebrovascular accident, constraint therapy, functional limitation, hemiplegia, motor skills, outcome assessment (healthcare), randomized controlled trials, rehabilitation, upper limb.