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Match and mismatch between objective and subjective improvements in upper limb function after stroke.

A Lex E Q van Delden1, C Lieke E Peper, Peter J Beek

  • 1Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam , Amsterdam , The Netherlands and.

Disability and Rehabilitation
|April 25, 2013
PubMed
Summary

Many stroke survivors experience a mismatch between objective upper-limb capacity gains and subjective performance improvements. Education and mood influence this match, impacting rehabilitation goal setting and outcome evaluation.

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Area of Science:

  • Neurorehabilitation
  • Clinical Outcomes Research
  • Patient-Reported Outcomes

Background:

  • Stroke frequently impairs upper-limb function, necessitating effective rehabilitation strategies.
  • Evaluating rehabilitation success requires aligning objective measures of motor capacity with subjective patient experiences of performance.

Purpose of the Study:

  • To identify stroke patients with matching objective and subjective upper-limb improvements.
  • To determine factors influencing concordance or discordance between capacity and performance outcomes post-stroke.

Main Methods:

  • 39 stroke patients were assessed over 17 weeks.
  • Upper-limb capacity measured by Action Research Arm Test (ARAT); subjective performance by Stroke Impact Scale Hand domain (SIS-Hand) and Motor Activity Log (MAL).

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Last Updated: May 12, 2026

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  • Logistic regression analyzed determinants of matching objective and subjective outcomes.

    • Main Results:

    • A significant association was found between ARAT and MAL improvements (p=0.011), but not ARAT and SIS-Hand.
    • Higher education and negative mood were associated with a mismatch between ARAT and SIS-Hand.
    • Predicted match probability was 0.83 for low-education/positive mood patients vs. 0.07 for high-education/negative mood patients.

    Conclusions:

    • Mismatches between objective capacity and subjective performance are common and clinically relevant in stroke rehabilitation.
    • Practitioners and patients should consider both capacity and self-perception measures when setting goals and evaluating upper limb recovery.
    • Future upper limb rehabilitation trials should incorporate both objective and subjective outcome measures to capture a comprehensive view of recovery.