Veerbeek Janne M, Winters Caroline, van Wegen Erwin E H, Kwakkel Gert
Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Amsterdam Movement Sciences, Amsterdam, the Netherlands.
PLoS One. 2018 Jan 12;13(1):e0189279. doi: 10.1371/journal.pone.0189279. eCollection 2018.
To investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting nor non-fitting would be determined, as well as within-subject generalizability to the paretic upper extremity (UE).
Prospective cohort study in which the Fugl-Meyer Assessment (FMA)-LE and FMA-UE were measured <72 hours and 6 months poststroke. Predicted maximum potential recovery was defined as [FMA-LEmax-FMA-LEinitial = 34 -FMA-LEinitial]. Hierarchical clustering in 202 first-ever ischemic stroke patients distinguished between fitting and not fitting the rule. Descriptive statistics determined whether fitters and non-fitters for LE were the same persons as for UE.
175 (87%) patients fitted the FMA-LE recovery rule. The observed average improvement of the fitters was 64% of the predicted maximum potential recovery. In the non-fitter group, the maximum initial FMA-LE score was 13 points. Fifty-one out of 78 patients (65%) who scored below the identified 14-point threshold at baseline fitted the FMA-LE rule. Non-fitters were more severely affected than fitters. All non-fitters of the FMA-LE rule did also not fit the proportional recovery rule for FMA-UE.
Proportional recovery seems to be consistent within subjects across LE and UE motor impairment at the hemiplegic side in first-ever ischemic hemispheric stroke subjects. Future studies should investigate prospectively distinguishing between fitters and not-fitters within the subgroup of patients who have initial low FMA-LE scores. Subsequently, patients could be stratified based on fitting or not fitting the recovery rule as this would impact rehabilitation management and trial design.
探讨(a) 自发性神经生物学恢复的比例恢复规则对偏瘫下肢（LE）运动功能的适用性；以及(b) 中风后该预后规则的适配者和非适配者的存在情况。若存在适配者和非适配者，则确定适配或非适配的临床阈值，以及该规则在个体内对偏瘫上肢（UE）的可推广性。
前瞻性队列研究，在中风后<72小时和6个月时测量Fugl-Meyer评估量表（FMA）的LE和UE部分。预测的最大潜在恢复定义为[FMA-LE最大值 - FMA-LE初始值 = 34 - FMA-LE初始值]。对202例首次发生缺血性中风的患者进行分层聚类，区分是否符合该规则。描述性统计确定LE的适配者和非适配者是否与UE的为同一批人。
175例（87%）患者符合FMA-LE恢复规则。适配者观察到的平均改善约为预测最大潜在恢复的64%。在非适配者组中，初始FMA-LE得分的最大值为13分。78例在基线时得分低于确定的14分阈值的患者中，有51例（约65%）符合FMA-LE规则。非适配者比适配者受影响更严重。所有FMA-LE规则的非适配者也不符合FMA-UE的比例恢复规则。
在首次发生缺血性半球性中风的患者中，比例恢复似乎在个体内偏瘫侧的LE和UE运动障碍中是一致的。未来的研究应前瞻性地调查在初始FMA-LE得分较低的患者亚组中区分适配者和非适配者。随后，患者可根据是否符合恢复规则进行分层，因为这将影响康复管理和试验设计。
