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Determining the Functional Status of the Corticospinal Tract Within One Week of Stroke
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Upper Limb Function 3 Months Post-Stroke: How Accurate Are Physiotherapist Predictions?

Sara Kjær Bastholm1, Iris Charlotte Brunner2, Camilla Biering Lundquist1

  • 1Hammel Neurorehabilitation and Research Centre, Hammel, Denmark.

Physiotherapy Research International : the Journal for Researchers and Clinicians in Physical Therapy
|April 1, 2025
PubMed
Summary

Physiotherapists accurately predicted upper limb function post-stroke only 41% of the time. Neither seniority nor education improved their prediction accuracy, suggesting a need for better prognostic tools in stroke rehabilitation.

Keywords:
physiotherapypredictionstrokeupper limb

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Area of Science:

  • Neurology
  • Rehabilitation Medicine
  • Clinical Prediction

Background:

  • Upper limb impairment is a common consequence of stroke.
  • Accurate prognosis of upper limb function is essential for effective rehabilitation strategies.

Purpose of the Study:

  • To evaluate the accuracy of physiotherapists' predictions of upper limb function recovery after stroke.
  • To investigate if physiotherapist seniority or education level influences prediction accuracy.
  • To compare physiotherapist predictions against a predictive algorithm.

Main Methods:

  • Included data from 81 stroke patients.
  • Physiotherapists made upper limb function predictions at 2 weeks post-stroke using clinical reasoning.
  • Upper limb function was assessed at 3 months post-stroke using the Action Research Arm Test (ARAT) to determine prediction accuracy (Correct Classification Rate - CCR).
  • Logistic regression and McNemar's test were used for statistical analysis.

Main Results:

  • The overall correct classification rate for physiotherapist predictions was 41%.
  • Predictions were most accurate for 'excellent' (75%) and 'poor' (71%) outcomes, but less accurate for 'limited' (22%) and 'good' (30%) outcomes.
  • No significant association was found between prediction accuracy and physiotherapist seniority or education level.
  • A predictive algorithm showed a non-statistically significant trend towards higher accuracy compared to physiotherapist predictions.

Conclusions:

  • Physiotherapist predictions of upper limb function recovery post-stroke have limited accuracy.
  • Seniority and education level do not appear to enhance physiotherapists' predictive capabilities.
  • The findings highlight the need for more robust and objective methods for upper limb function prognosis in stroke rehabilitation.