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. 2018 Jan 12;13(1):e0189279.
doi: 10.1371/journal.pone.0189279. eCollection 2018.

Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?

Janne M Veerbeek  1   2   3   4   5 , Caroline Winters  1   2   3 , Erwin E H van Wegen  1   2   3 , Gert Kwakkel  1   2   3   6   7
Affiliations

Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?

Janne M Veerbeek et al. PLoS One. .

Abstract

Objective: To investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting nor non-fitting would be determined, as well as within-subject generalizability to the paretic upper extremity (UE).

Methods: Prospective cohort study in which the Fugl-Meyer Assessment (FMA)-LE and FMA-UE were measured <72 hours and 6 months poststroke. Predicted maximum potential recovery was defined as [FMA-LEmax-FMA-LEinitial = 34 -FMA-LEinitial]. Hierarchical clustering in 202 first-ever ischemic stroke patients distinguished between fitting and not fitting the rule. Descriptive statistics determined whether fitters and non-fitters for LE were the same persons as for UE.

Results: 175 (87%) patients fitted the FMA-LE recovery rule. The observed average improvement of the fitters was ~64% of the predicted maximum potential recovery. In the non-fitter group, the maximum initial FMA-LE score was 13 points. Fifty-one out of 78 patients (~65%) who scored below the identified 14-point threshold at baseline fitted the FMA-LE rule. Non-fitters were more severely affected than fitters. All non-fitters of the FMA-LE rule did also not fit the proportional recovery rule for FMA-UE.

Conclusions: Proportional recovery seems to be consistent within subjects across LE and UE motor impairment at the hemiplegic side in first-ever ischemic hemispheric stroke subjects. Future studies should investigate prospectively distinguishing between fitters and not-fitters within the subgroup of patients who have initial low FMA-LE scores. Subsequently, patients could be stratified based on fitting or not fitting the recovery rule as this would impact rehabilitation management and trial design.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Exclusion flow-chart.
Fig 2
Fig 2. Proportional recovery of the lower extremity: Predicted maximum potential recovery (FMA-LEmax−FMA-LEinitial) versus observed ΔFMA-LE.
◻ subgroup of fitters (N = 175; blue), ○ subgroup of non-fitters (N = 27; red). For the fitters, R2 of the FMA-LEmax for ΔFMA-LE was 76.8%, and the regression line y = 0.64 (95%CI 0.59–0.69) x– 0.24 (95%CI -1.15–0.66). Note that the two data points at the top right corner were also identified as a subgroup in the hierarchical cluster analysis. However, they were added to the ‘fitter’ group because their ΔFMA-LEobserved was almost identical with the predicted maximum potential recovery. Also, note that there were 15 patients who scored 1 to 3 points lower on the FMA-LE at 6 months, in comparison to the baseline measurement. See further explanation in text. CI, Confidence Interval; FMA, Fugl-Meyer Assessment; LE, Lower Extremity.
Fig 3
Fig 3. Consistency of proportional recovery between FMA-LE and FMA-UE expressed in percentages (%).
◻ subgroup of FMA-UE fitters (N = 137; blue), ◼ subgroup of FMA-UE non-fitters (N = 65; blue), ○ subgroup of FMA-LE fitters (N = 175; red), ● subgroup of FMA-LE non-fitters (N = 27; red). FMA, Fugl-Meyer Assessment; LE, Lower Extremity; UE, Upper Extremity.
See this image and copyright information in PMC

References

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