Nonparetic forearm fracture and early upper-limb manual function outcomes after stroke rehabilitation

Upper-limb recovery after stroke may be affected by conditions that restrict the use of the nonparetic limb during early rehabilitation. We evaluated whether nonparetic forearm fracture was associated with early manual function outcomes after inpatient stroke rehabilitation. This retrospective 1 : 3 matched cohort study included adults with ischemic or hemorrhagic stroke admitted between January 2018 and November 2025. Patients with imaging-confirmed nonparetic forearm fracture treated with conservative immobilization were matched 1 : 3 to patients without forearm fracture. The primary outcome was the 4-week manual function test score. Manual function test scores at rehabilitation admission, 4 weeks, and 4-week change were summarized descriptively. The primary analysis used matched-set fixed-effects regression with cluster-robust standard errors. The matched cohort included 244 patients, comprising 61 with fracture and 183 without fracture. At 4 weeks, the fracture group had lower scores than the no-fracture group (18.6 ± 5.2 vs. 22.5 ± 6.0; P < 0.001). In matched-set fixed-effects analysis, fracture status was associated with a lower 4-week manual function test score (β = -3.72, 95% confidence interval: -4.75 to -2.69; P < 0.001). Nonparetic forearm fracture was associated with worse early manual function after inpatient stroke rehabilitation.