Department of Medicine, University of Auckland, Auckland 1142, New Zealand.
Brain. 2012 Aug;135(Pt 8):2527-35. doi: 10.1093/brain/aws146. Epub 2012 Jun 10.
Stroke is a leading cause of adult disability and the recovery of motor function is important for independence in activities of daily living. Predicting motor recovery after stroke in individual patients is difficult. Accurate prognosis would enable realistic rehabilitation goal-setting and more efficient allocation of resources. The aim of this study was to test and refine an algorithm for predicting the potential for recovery of upper limb function after stroke. Forty participants were prospectively enrolled within 3 days of ischaemic stroke. First, shoulder abduction and finger extension strength were graded 72 h after stroke onset to compute a shoulder abduction and finger extension score. Secondly, transcranial magnetic stimulation was used to assess the functional integrity of descending motor pathways to the affected upper limb. Third, diffusion-weighted magnetic resonance imaging was used to assess the structural integrity of the posterior limbs of the internal capsules. Finally, these measures were combined in the PREP algorithm for predicting an individual's potential for upper limb recovery at 12 weeks, measured with the Action Research Arm Test. A cluster analysis was used to independently group patients according to Action Research Arm Test score at 12 weeks, for comparison with predictions from the PREP algorithm. There was excellent correspondence between the cluster analysis of Action Research Arm Test score at 12 weeks and predictions made with the PREP algorithm. The algorithm had positive predictive power of 88%, negative predictive power of 83%, specificity of 88% and sensitivity of 73%. This study provides preliminary data in support of the PREP algorithm for the prognosis of upper limb recovery in individual patients. PREP may enable tailored planning of rehabilitation and more accurate stratification of patients in clinical trials.
中风是导致成年人残疾的主要原因，而运动功能的恢复对于日常生活活动的独立性非常重要。预测个体中风后运动功能的恢复情况非常困难。准确的预后可以帮助设定切合实际的康复目标，并更有效地分配资源。本研究旨在检验和完善一种预测中风后上肢功能恢复潜力的算法。40 名参与者在缺血性中风后 3 天内被前瞻性纳入研究。首先，在中风发作后 72 小时评估肩部外展和手指伸展的力量，以计算肩部外展和手指伸展评分。其次，使用经颅磁刺激评估影响上肢的下行运动通路的功能完整性。第三，使用弥散加权磁共振成像评估内囊后肢的结构完整性。最后，将这些测量结果组合到 PREP 算法中，以预测个体在 12 周时的上肢恢复潜力，使用动作研究上肢测试进行评估。聚类分析用于根据动作研究上肢测试在 12 周时的评分独立分组患者，以与 PREP 算法的预测进行比较。在 12 周时动作研究上肢测试评分的聚类分析与 PREP 算法的预测结果之间存在极好的一致性。该算法的阳性预测值为 88%，阴性预测值为 83%，特异性为 88%，敏感性为 73%。本研究初步支持 PREP 算法用于预测个体上肢恢复的预后。PREP 可能使康复计划更具针对性，并更准确地对临床试验中的患者进行分层。
