Association Between Upper Limb Impairment and Function Within One Month Post Stroke and Self-care at Six Months

Stroke leaves many people with upper limb impairments which significantly affect function and Quality Of Life (QOL). Most studies report outcomes at the impairment and activity level. Less attention has been paid to real-life use of the affected upper limb in daily activities. Self-reported measures of performance of activity in daily life using the affected upper limb is important to obtain as people may have minimal deficits on impairment and activity level outcomes yet still have significant difficulties performing self-care and other Activities of Daily Living (ADLs). These difficulties have an important impact on QOL. Discovering easy clinical measures that are associated with the ability to perform ADLs in the long-term is vital as this can lead to more effective care planning by providers, more realistic expectations for survivors, and more efficient allocation of time and resources.

This exploratory study investigated the association between affected upper limb movements from the Upper Extremity Fugl-Meyer Assessment (UEFMA) as well as grip and grasp items from the Action Research Arm Test (ARAT) measured within thirty days post stroke and the self-care domain of the EuroQol-5D-5L measured at six months post stroke. These higher-level affected arm movements require some degree of corticospinal tract function which is a known predictor of functional outcome.

Baseline clinical and six-month EuroQol-5D-5L data were obtained from sixty participants who completed a randomized clinical trial that evaluated robotically facilitated virtual reality for the upper limb in the subacute period post stroke. Cross tabs were used to quantify the association between the baseline ability to perform higher level affected arm movements and the ability to wash and dress oneself at six months post stroke using the self-rated EuroQol-5D-5L health related QOL measure.

The ability to perform higher level affected arm movements that require some degree of corticospinal tract function within thirty days post stroke was significantly associated with self-care at six months post stroke in a group of moderate to severely impaired individuals with stroke.

We propose easy to assess hand, wrist, and arm movements that may be effective clinical tools to project independence with self-care in the long term in similar populations.