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PREDICTION OF ARM FUNCTION WITHIN ONE YEAR AFTER STROKE USING A SHORT ASSESSMENT

Poster (konferens)
Författare Hanna C Persson
Margit Alt Murphy
Anna Danielsson
Åsa Lundgren Nilsson
Katharina S Sunnerhagen
Publicerad i The 8th World Congress for NeuroRehabilitation
Volym Ref no 319
Nummer/häfte PP-156
Publiceringsår 2014
Publicerad vid Institutionen för neurovetenskap och fysiologi
Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering
Språk en
Ämnesord prognosis, stroke, upper extremity
Ämneskategorier Klinisk medicin, Neurologi

Sammanfattning

Background: A clinical test is needed, with the possibility through an early assessment to correctly predict clinical relevant arm function in patients with stroke, which would be appropriate for the patient, staff and when planning for future care and rehabilitation. Aims: There are two purposes of the present study. First; investigate if items from the Action Research Arm Test (ARAT) can be extracted to create a diagnostic test easy to perform in the clinic during the acute stage of stroke with the possibility to predict upper limb function and activity, second; assess the new test’s possibility to predict sufficient motor function ability to drink from a glass with the impaired arm. Methods: In the study 112 patients were assessed at day 3, day 10, week 4 and month 12 after stroke onset. Clinically feasible items from the ARAT able to detect sufficient motor function ability to drink from a glass with the impaired arm during the first year after stroke were selected in a structure process. An appropriate cut-off for the diagnostic test was chosen with Receiver Operation Characteristic (ROC) curves. In the second step the chosen items’ possibility to predict upper extremity function and activity were tested with 2-way contingency table. Results: Two items from ARAT; “Pour water from glass to glass” and “Place hand on top of head” were structured selected to a diagnostic test with a total sum of 0-6 p. A cut-off level of 0-1/2-6 p was identified, having an Area Under the Curve (AUC) of 0.91-0.99 presented in the ROC-curves. The percent of correctly predicted patients over all were between 80.8% and 96.4% in the different test occasions. The diagnostic test had the ability to correctly predict motor function of patients having some dexterity at day 3, Negative Predictive Value (NPV) day 10, 0.98, week 4 and month 12 1.0. The Positive Predictive Value (PPV) was high day 10, 0.95, but lower thereafter; week 4, 0.77, month 12, 0.61. From assessments week 4, the PPV/NPV in month 12 were 0.79/1.0. Conclusions: It is possible to, from a short assessment (two items from ARAT) at day 3 post stroke predict sufficient motor function ability to drink from a glass with the paretic arm during the first year. The percentage of correct over all prediction varies between 81 -94%. Keywords: prognosis, stroke, upper extremity

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