Patient-reported measures provide unique insights into motor function after stroke

Abstract

Background and purpose: Patient-reported outcome measures have been found useful in many disciplines but have received limited evaluation after stroke. The current study investigated the relationship that patient-reported measures have with standard impairment and disability scales after stroke.

Methods: Patients with motor deficits after stroke were scored on standard assessments including the National Institutes of Health Stroke Scale, modified Rankin Scale, and Fugl-Meyer motor scale, and on 2 patient-reported measures, the hand function domain of the Stroke Impact Scale, which documents difficulty of hand motor usage, and the amount of use portion of the Motor Activity Log, which records amount of arm motor usage.

Results: The 43 participants had mild disability (median modified Rankin Scale=2), moderate motor deficits (Fugl-Meyer motor scale=46 ± 22), and mild cognitive/language deficits. The 2 patient-reported outcome measures, Stroke Impact Scale and Motor Activity Log, were sensitive to the presence of arm motor deficits. Of 21 patients classified as having minimal or no impairment or disability by the National Institutes of Health Stroke Scale or modified Rankin Scale (score of 0-1), 15 (71%) reported difficulty with hand movements by the Stroke Impact Scale score or reduced arm use by the Motor Activity Log score. Furthermore, of 14 patients with a normal examination, 10 (71%) reported difficulty with hand movements or reduction in arm use.

Conclusions: Patient-reported measures were a unique source of insight into clinical status in the current population. Motor deficits were revealed in a majority of patients classified by standard scales as having minimal or no disability, and in a majority of patients classified as having no deficits.

Figure 1. A range of arm symptoms is present among participants classified as having minimal or no impairment

Relationship between the NIHSS and (A) the Stroke Impact Scale (SIS) hand domain, reflecting difficulty of hand use, and (B) the Motor Activity Log (MAL) amount of arm use. The bracket indicates patients with an NIHSS score of 0-1, i.e., minimal or no neurologic impairment, among whom a range of SIS and MAL scores are present.

Figure 2. A range of arm symptoms is present among participants classified as having no arm motor impairment

Relationship between UE FM motor score and (A) the SIS, and (B) the MAL. The arrow indicates patients with no motor impairment, i.e., a normal UE FM score of 66, among whom a range of SIS and MAL scores are present.