Evolution and prediction of mismatch between observed and perceived upper limb function after stroke: a prospective, longitudinal, observational cohort study

Abstract

Background A previously shown ‘mismatch’ group of patients with good observed upper limb (UL) motor function but low perceived UL activity at six months post stroke tends to use the affected UL less in daily life than would be expected based on clinical tests, and this mismatch may also be present at 12 months. We aimed to confirm this group in another cohort, to investigate the evolution of this group from six to 12 months, and to determine factors on admission to inpatient rehabilitation and at 6 months that can discriminate between mismatch and good match groups at 12 months. Methods Persons after stroke were recruited on rehabilitation admission and re-assessed at six and 12 months. Observed UL function was measured with the upper extremity subscale of the Fugl-Meyer Assessment (FMA-UE) and perceived UL activity by the hand subscale of the Stroke Impact Scale 3.0 (SIS-Hand). We defined mismatch as good observed UL function (FMA-UE > 50/66) but low perceived activity (SIS-Hand≤75/100). Potential discriminators at admission and 6 months (demographic characteristics, stroke characteristics, UL somatosensory function, cognitive deficits, mental function and activity) were statistically compared for match and mismatch groups at 12 months. Results We included 60 participants (female: 42%) with mean (SD) age of 65 (12) years. We confirmed a mismatch group of 11 (18%) patients at 6 months, which increased to 14 (23%) patients at 12 months. In the mismatch group compared to the good match group at 12 months, patients had a higher stroke severity and more somatosensory impairments on admission and at 6 months. Conclusions We confirmed a group of patients with good observed UL function but low perceived activity both at six and at 12 months post stroke. Assessment of stroke severity and somatosensory impairments on admission into rehabilitation could determine mismatch at 12 months and might warrant intervention. However, large differences in clinical outcomes between patients in the mismatch group indicate the importance of tailoring training to the individual needs.

Correlation between kinetic and kinematic measures, clinical tests and subjective self-evaluation questionnaires of the affected upper limb in people after stroke

“…Self-evaluation questionnaires should be considered for wider use in the clinical evaluation of a patient's stroke recovery, since they add important information on the individual's functional status, which is not reflected in the clinical tests. Neglecting to account for the patient's perspective -that is, how they perceive their rehabilitation progress -in all phases of poststroke rehabilitation is inadvisable: A discrepancy between clinical evaluation scores and self-evaluation reports (Dromerick et al, 2006;van Delden et al, 2013;Persson et al, 2015;Banina et al, 2017;Essers et al, 2019;Cameron et al, 2020;Essers et al, 2021) suggests that the clinical evaluation process may have a blind spot. Post-stroke individuals often find their functional abilities unsatisfactory, even while their scores on clinical tests are high or even maximal (Han et al, 2013;Stewart and Cramer, 2013).…”

Concurrent Validity and Responsiveness of Clinical Upper Limb Outcome Measures and Sensor-based Arm Use Metrics within the First Year after Stroke: A Longitudinal Cohort Study

“…Discrepancies between outcome domains might be inherent to their different measurement constructs. Designated as the match-mismatch paradox, discrepancies between capacity and perceived/real-life performance of the upper limb have been investigated extensively 14,[91][92][93][94][95] . The disparity between capacity and perceived performance or between perceived performance and AU metrics could be due to underestimating or overestimating the individuals' perceptions.…”

“…Concurrent validity is often evaluated between unilateral capacity and the arm use symmetry between the affected and nonaffected. 21,93,95,99 . Interestingly, our data shows that symmetry metrics are consistently stronger associated with unilateral capacity than unilaterally affected AU.…”