Revisiting poststroke upper limb stratification : Resilience in a larger cohort

Journal article


Varley, Benjamin J., Shiner, Christine T., Johnson, Liam, McNulty, Penelope A. and Thompson Butel, A.. (2021). Revisiting poststroke upper limb stratification : Resilience in a larger cohort. Neurorehabilitation and Neural Repair. 35(3), pp. 280-289. https://doi.org/10.1177/1545968321992048
AuthorsVarley, Benjamin J., Shiner, Christine T., Johnson, Liam, McNulty, Penelope A. and Thompson Butel, A.
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.

KeywordsBox and Block Test; Grooved Pegboard Test; stratification; upper limb; motor function; stroke; classification
Year2021
JournalNeurorehabilitation and Neural Repair
Journal citation35 (3), pp. 280-289
PublisherSAGE Publications Inc.
ISSN1545-9683
Digital Object Identifier (DOI)https://doi.org/10.1177/1545968321992048
Scopus EID2-s2.0-85100486167
Research or scholarlyResearch
Page range280-289
FunderNational Health and Medical Research Council
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online01 Feb 2021
Publication process dates
Accepted19 Jul 2021
Deposited27 Jul 2021
Grant IDNHMRC/630440
NHMRC/1077898
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