Revisiting Poststroke Upper Limb Stratification: Resilience in a Larger Cohort

Abstract

Background Upper limb (UL) impairment in stroke survivors is both multifactorial and heterogeneous. Stratification of motor function helps identify the most sensitive and appropriate assessments, which in turn aids the design of effective and individualized rehabilitation strategies. We previously developed a stratification method combining the Grooved Pegboard Test (GPT) and Box and Block Test (BBT) to stratify poststroke UL motor function. Objective To investigate the resilience of the stratification method in a larger cohort and establish its appropriateness for clinical practice by investigating limitations of the GPT completion time. Methods Post hoc analysis of motor function for 96 community-dwelling participants with stroke (n = 68 male, 28 female, age 60.8 ± 14 years, 24.4 ± 36.6 months poststroke) was performed using the Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment (F-M), BBT, and GPT. Hypothesis-free and hypothesis-based hierarchical cluster analyses were conducted to determine the resilience of the stratification method. Results The hypothesis-based analysis identified the same functional groupings as the hypothesis-free analysis: low (n = 32), moderate (n = 26), and high motor function (n = 38), with 3 exceptions. Thirty-three of the 38 participants with fine manual dexterity completed the GPT in ≤5 minutes. The remaining 5 participants took 6 to 25 minutes to place all 25 pegs but used alternative movement strategies to complete the test. The GPT time restriction changed the functional profile of the moderate and high motor function groups leading to more misclassifications. Conclusion The stratification method unambiguously classifies participants by UL motor function. While the inclusion of a 5-minute cutoff time for the GPT is preferred for clinical practice, it is not recommended for stratification purposes.

Sensor-Based Categorization of Upper Limb Performance in Daily Life of Persons With and Without Neurological Upper Limb Deficits

“…The identified categories of UL performance that emerged in this analysis could be useful for future trials of persons with UL impairments following subsequent, future validation studies. Categories that emerged in this analysis have stratified participants into groupings with similar overall UL performance, representing a profile of arm activity in daily life (38,55,70). Individuals within each category have similar ranges of each performance variable included (e.g., duration, magnitude, variability and symmetry) that formed the 5-clusters.…”

“…Combining the three cohorts provided a broad sampling of UL performance variables. With respect to power analyses, there is no agreed upon sample required for a cluster analysis (37,38), however the combined cohorts yield a sample size of over 200 individuals, which was deemed sufficient to proceed with a cluster analysis (39).…”

Uncertainty in illness and coping styles: Moderating and mediating effects of resilience in stroke patients

“…Resilience is a way to help alleviate stress and emotional distress. It could affect stroke patients' responses to rehabilitation and long-term functional outcomes[ 16 ]. A longitudinal study regarding the resilience of stroke patients showed that the confrontation coping style was positively related to resilience[ 17 ].…”

A Prototype of an Electronic Pegboard Test to Measure Hand-Time Dexterity with Impaired Hand Functionality

“…The GPT has been used previously in diagnosing many diseases [2][3][4][5][6][7][8][9][10][11][12]. For example, Amirjani et al used the GPT to assess the carpal tunnel syndromes.…”

“…The Grooved Pegboard Test was also used to assess the fine dexterity after virtual reality (VR) immersion and cyber-sickness for 89 participants aged between 19 and 36 years [8]. In addition, the GPT was used to assess the hand dexterity for various diseases [9][10][11][12].…”