Comparing Home Upper Extremity Activity with Clinical Evaluations of Arm Function in Chronic Stroke.

OBJECTIVE

To determine if clinical evaluations of post-stroke arm function correspond to everyday motor performance indexed by arm accelerometers.

DESIGN

Cross-sectional study analyzing baseline data from a larger trial (NCT02665052).

SETTING

Outpatient research center.

PARTICIPANTS

Twenty community-dwelling adults with chronic arm motor deficits (stroke≥6mo).

INTERVENTION

72-hours of home wrist-worn accelerometry during normal routine.

MAIN OUTCOME MEASURES

Clinical evaluations included the Fugl-Meyer (FM), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), and two self-assessments: the Motor Activity Log (MAL) and hand motor subscale of the Stroke Impact Scale (SIS). Accelerometer-derived variables included quantifications of movement intensity (magnitude) and duration of arm use.

RESULTS

Participants had moderate arm impairment (FM 36.1 ± 9.4). The accelerometer-derived mean magnitude ratio correlated significantly with the FM ( = 0.60, p < 0.01), WMFT functional score ( = 0.59, p < 0.01), and ARAT ( = 0.50, p < 0.05). The hours of use ratio correlated with the MAL amount of use ( = 0.58, p < 0.01) and quality of movement ( = 0.61, p < 0.01). Total paretic hours did not correlate with the FM, WMFT or ARAT, and intensity variables did not correlate with the MAL or SIS.

CONCLUSIONS

Participants with higher baseline function had greater intensity of paretic arm movement at home; similarly, those who perceived they had less disability used their paretic arm more relative to their non-paretic arm. However, some participants with higher clinical scores did not exhibit greater arm use in everyday life, possibly due to neglect and learned non-use. Therefore, individualized home accelerometry profiles could provide valuable insight to better tailor post-stroke rehabilitation.