Revisiting Poststroke Upper Limb Stratification: Resilience in a Larger Cohort.

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Assessment

Background:

• Upper limb (UL) impairment after stroke is complex and varied.
• Effective stroke rehabilitation requires precise motor function assessment and stratification.
• A prior method combined the Grooved Pegboard Test (GPT) and Box and Block Test (BBT) for UL motor function stratification.

Purpose of the Study:

• To validate the robustness of the UL motor function stratification method in a larger patient group.
• To assess the suitability of the stratification method for routine clinical use.
• To identify limitations associated with the Grooved Pegboard Test (GPT) completion time.

Main Methods:

• Post hoc analysis of motor function data from 96 community-dwelling stroke survivors.
• Utilized Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment (F-M), BBT, and GPT.
• Employed hypothesis-free and hypothesis-based hierarchical cluster analyses to test stratification resilience.

Main Results:

• Hierarchical cluster analysis confirmed three functional groups: low (n=32), moderate (n=26), and high (n=38) motor function.
• A 5-minute time restriction on the GPT led to misclassification in moderate and high motor function groups.
• Five participants with fine dexterity exceeded the 5-minute GPT limit, using alternative strategies.

Conclusions:

• The combined GPT and BBT method reliably stratifies UL motor function in stroke survivors.
• A 5-minute GPT time cutoff is practical for clinical assessment but compromises stratification accuracy.
• The GPT time restriction should not be used when stratifying patients for rehabilitation planning.