Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr;37(4):557-568.
doi: 10.1177/02692155221134413. Epub 2022 Oct 31.

Responsiveness and trajectory of changes in the rating of everyday arm-use in the community and home (REACH) scale over the first-year post-stroke

Lisa A Simpson  1 , Kathryn S Hayward  2   3 , Lara A Boyd  3 , Beverley C Larssen  1 , W Ben Mortenson  4 , Amy Schneeberg  5 , Noah D Silverberg  6 , Janice J Eng  3
Affiliations

Responsiveness and trajectory of changes in the rating of everyday arm-use in the community and home (REACH) scale over the first-year post-stroke

Lisa A Simpson et al. Clin Rehabil. 2023 Apr.

Abstract

Objective: To examine the trajectory of the Rating of Everyday Arm-use in the Community and Home (REACH) scores over the first-year post-stroke, determine if REACH scores are modified by baseline impairment level and explore the responsiveness of the REACH scale through hypothesis testing.

Design: Consecutive sample longitudinal study.

Setting: Participants were recruited from an acute stroke unit and followed up at three, six, and 12 months post-stroke.

Participants: Seventy-three participants with upper limb weakness (Shoulder Abduction and Finger Extension score ≤ 8).

Main measures: The REACH scale is a six-level self-report classification scale that captures how the affected upper limb is being used in one's own environment. The Fugl-Meyer Upper Limb Assessment (FMA-UL), Stroke Upper Limb Capacity Scale (SULCS), accelerometer-based activity count ratio and Global Rating of Change Scale (GRCS) were used to capture upper limb impairment, capacity, and use.

Results: The following proportions of participants improved at least one REACH level: 64% from baseline to three months, 37% from three to six months and 13% from six to 12 months post-stroke. The trajectory of REACH scores over time was associated with baseline impairment. Change in REACH had a moderate correlation to change in SULCS and the GRCS but not FMA-UL or the activity count ratio.

Conclusions: Results of hypothesis testing provide preliminary evidence of the responsiveness of the REACH scale. On average, individuals with severe impairment continued to show improvement in use over the first year, while those with mild/moderate impairment plateaued and a small proportion decreased in the early chronic phase.

Keywords: Stroke; longitudinal study; responsiveness; upper limb use.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Summary of included participants.
Figure 2.
Figure 2.
Predicted REACH scores over the first-year post-stroke. REACH Scale Levels: 0-no use/exercise only; 1-assist or easy reach; 2-some reach and grasp with hand manipulation; 4-everyday use unless potential negative consequences; 5-full use. Points (circles and triangles) represent predicted mean REACH scores at the four timepoints for the respective impairment groups obtained from the final linear mixed effects model (i.e. model 3 in Table 4). Intervals indicate  +  /− one standard error.
Figure 3.
Figure 3.
Scatterplots of change scores in REACH and measures of upper limb impairment, capacity, and use between baseline and three months post-stroke. Note: REACH: Rating of Everyday Arm-use in the Community and Home Scale; FMA-UL: Fugl-Meyer Upper Limb Assessment; SULCS: Stroke Upper Limb Capacity Scale; AC: activity counts; GRCS: Global Rating of Change Scale; A: n  =  61; B: n  =  56; C: n  =  25; D: n  =  54.
See this image and copyright information in PMC

References

    1. Simpson LA, Eng JJ, Backman CL, et al. Rating of everyday arm-use in the community and home (REACH) scale for capturing affected arm-use after stroke: development, reliability and validity. PLoS One 2013; 8: e83405. - PMC - PubMed
    1. Assadi SH, Gross-Nevo RF, Dudkiewicz I, et al. Improvement of the upper extremity at the subacute stage poststroke: does hand dominance play a role? Neurorehabil Neural Repair 2020; 34: 1030–1037. - PubMed
    1. Bernhardt J, Hayward KS, Kwakkel G, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: the stroke recovery and rehabilitation roundtable taskforce. Neurorehabil Neural Repair 2017; 31: 793–799. - PubMed
    1. Borschmann KN, Hayward KS. Recovery of upper limb function is greatest early after stroke but does continue to improve during the chronic phase: a two-year observational study. Physiotherapy 2020; 107: 216–223. - PubMed
    1. Regtershcot GRH, Bussmann JBJ, Fanchamps MHJ, et al. Objectively measured arm use in daily life improves during the first 6 months poststroke: a longitudinal observational cohort study. J Neuroeng Rehabil 2021; 18: 51. - PMC - PubMed