Graduate Program in Rehabilitation Sciences, 8166University of British Columbia, Vancouver, Canada.
Departments of Physiotherapy, Medicine (RMH) and 56369Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
Clin Rehabil. 2023 Apr;37(4):557-568. doi: 10.1177/02692155221134413. Epub 2022 Oct 31.
To examine the trajectory of the Rating of Everyday Arm-use in the Community and Home (REACH) scores over the first-year post-stroke, determine if REACH scores are modified by baseline impairment level and explore the responsiveness of the REACH scale through hypothesis testing.
Consecutive sample longitudinal study.
Participants were recruited from an acute stroke unit and followed up at three, six, and 12 months post-stroke.
Seventy-three participants with upper limb weakness (Shoulder Abduction and Finger Extension score ≤ 8).
The REACH scale is a six-level self-report classification scale that captures how the affected upper limb is being used in one's own environment. The Fugl-Meyer Upper Limb Assessment (FMA-UL), Stroke Upper Limb Capacity Scale (SULCS), accelerometer-based activity count ratio and Global Rating of Change Scale (GRCS) were used to capture upper limb impairment, capacity, and use.
The following proportions of participants improved at least one REACH level: 64% from baseline to three months, 37% from three to six months and 13% from six to 12 months post-stroke. The trajectory of REACH scores over time was associated with baseline impairment. Change in REACH had a moderate correlation to change in SULCS and the GRCS but not FMA-UL or the activity count ratio.
Results of hypothesis testing provide preliminary evidence of the responsiveness of the REACH scale. On average, individuals with severe impairment continued to show improvement in use over the first year, while those with mild/moderate impairment plateaued and a small proportion decreased in the early chronic phase.
考察社区和家庭日常生活手臂使用评估（REACH）评分在中风后第一年的变化轨迹，确定 REACH 评分是否受基线损伤水平的影响，并通过假设检验探索 REACH 量表的反应能力。
连续样本纵向研究。
参与者从急性中风病房招募，并在中风后 3、6 和 12 个月进行随访。
73 名上肢无力（肩外展和手指伸展评分≤8）的患者。
REACH 量表是一种六级自我报告分类量表，用于评估患侧上肢在自身环境中的使用情况。采用 Fugl-Meyer 上肢评定（FMA-UL）、中风上肢能力量表（SULCS）、基于加速度计的活动计数比和整体变化评级量表（GRCS）来评估上肢损伤、能力和使用情况。
至少提高一个 REACH 级别的参与者比例如下：从基线到 3 个月时为 64%，从 3 个月到 6 个月时为 37%，从 6 个月到 12 个月时为 13%。REACH 评分随时间的轨迹与基线损伤有关。REACH 的变化与 SULCS 和 GRCS 的变化呈中度相关，但与 FMA-UL 或活动计数比无关。
假设检验的结果提供了 REACH 量表反应能力的初步证据。平均而言，严重损伤的个体在第一年继续表现出使用的改善，而轻度/中度损伤的个体则在早期慢性阶段达到平台期，一小部分个体的使用情况下降。
