Factors associated with upper extremity use after stroke: a scoping review of accelerometry studies

A discrepancy between the level of impairment at the upper extremity (UE) and its use in activities of daily life is frequently observed in individuals who have experienced a stroke. Wrist-worn accelerometers allow an objective and valid measure of UE use in everyday life. Accelerometer studies have shown that a wide range of factors beyond UE impairment can influence UE use. This scoping review aims to identify factors associated with UE use and to investigate the influence of different types of accelerometry metrics on these associations.

A search using CINHAL, Embase, MEDLINE, Compendex, and Web of Science Core Collection databases was performed. Studies that assessed the association between UE use quantified with accelerometers and factors related to the person or their environment in individuals with stroke were included. Data related to study design, participants characteristics, accelerometry methodology (absolute vs. relative UE use metrics), and associations with personal and environmental factors were extracted.

Fifty-four studies were included. Multiple studies consistently reported associations between relative UE use and stroke severity, UE motor impairment, unimanual capacity, bimanual capacity, and mobility. In contrast, there were inconsistent associations with factors such as neglect and concordance between dominance and side of paresis and a consistent lack of association between relative UE use and time since stroke, sex, and age. Metrics of absolute paretic UE use yielded different results regarding their association with personal and environmental factors, as they were more influenced by factors related to physical activity and less associated with factors related to UE capacity.

Healthcare providers should recognize the complexity of the relationship between UE use and impairment and consider additional factors when selecting assessments during rehabilitation to identify patients at risk of underutilizing their paretic arm in daily life. Future research in this domain should preconize relative UE use metrics or multi-sensors method to control for the effect of physical activity.