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      An overview of systematic reviews on upper extremity outcome measures after stroke

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          Abstract

          Background

          Although use of standardized and scientifically sound outcome measures is highly encouraged in clinical practice and research, there is still no clear recommendation on which tools should be preferred for upper extremity assessment after stroke. As the aims, objectives and methodology of the existing reviews of the upper extremity outcome measures can vary, there is a need to bring together the evidence from existing multiple reviews. The purpose of this review was to provide an overview of evidence of the psychometric properties and clinical utility of upper extremity outcome measures for use in stroke, by systematically evaluating and summarizing findings from systematic reviews.

          Methods

          A comprehensive systematic search was performed including systematic reviews from 2004 to February 2014. A methodological quality appraisal of the reviews was performed using the AMSTAR-tool.

          Results

          From 13 included systematic reviews, 53 measures were identified of which 13 met the standardized criteria set for the psychometric properties. The strongest level of measurement quality and clinical utility was demonstrated for Fugl-Meyer Assessment, Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Wolf Motor Function Test and ABILHAND.

          Conclusions

          This overview of systematic reviews provides a comprehensive systematic synthesis of evidence on which outcome measures demonstrate a high level of measurement quality and clinical utility and which can be considered as most suitable for upper extremity assessment after stroke. This overview can provide a valuable resource to assist clinicians, researchers and policy makers in selection of appropriate outcome measures.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12883-015-0292-6) contains supplementary material, which is available to authorized users.

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          Most cited references36

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          What do motor "recovery" and "compensation" mean in patients following stroke?

          There is a lack of consistency among researchers and clinicians in the use of terminology that describes changes in motor ability following neurological injury. Specifically, the terms and definitions of motor compensation and motor recovery have been used in different ways, which is a potential barrier to interdisciplinary communication. This Point of View describes the problem and offers a solution in the form of definitions of compensation and recovery at the neuronal, motor performance, and functional levels within the framework of the International Classification of Functioning model.
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            Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study.

            Time course and degree of recovery of upper extremity (UE) function after stroke and the influence of initial UE paresis were studied prospectively in a community-based population of 421 consecutive stroke patients admitted acutely during a 1-year period. UE function was assessed weekly, using the Barthel Index subscores for feeding and grooming. UE paresis was assessed by the Scandinavian Stroke Scale subscores for hand and arm. The best possible UE function was achieved by 80% of the patients within 3 weeks after stroke onset and by 95% within 9 weeks; in patients with mild UE paresis, function was achieved within 3 and 6 weeks, respectively, and in patients with severe UE paresis within 6 and 11 weeks, respectively. Full UE function was achieved by 79% of patients with mild UE paresis and only by 18% of patients with severe UE paresis. A valid prognosis of UE function can be made within 3 and 6 weeks in patients with mild and severe UE paresis, respectively. Further recovery of UE function should not be expected after 6 and 11 weeks respectively, in these groups of patients.
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              Factors influencing stroke survivors' quality of life during subacute recovery.

              Health-related quality of life (HRQOL) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery. This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery. Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial (Extremity Constraint-Induced Therapy Evaluation). HRQOL was assessed using the Stroke Impact Scale (SIS), Version 3.0. The Wolf Motor Function Test documented functional recovery of the hemiplegic upper extremity. Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains. Age, gender, education level, stroke type, concordance (paretic arm=dominant hand), upper extremity motor function (Wolf Motor Function Test), and comorbidities were associated across SIS domains. Poorer HRQOL in the physical domain was associated with age, nonwhite race, more comorbidities, and reduced upper-extremity function. Stroke survivors with more comorbidities reported poorer HRQOL in the area of memory and thinking, and those with an ischemic stroke and concordance reported poorer communication. Although results may not generalize to lower functioning stroke survivors, individual characteristics of persons with mild to moderate stroke may be important to consider in developing comprehensive, targeted interventions designed to maximize recovery and improve HRQOL.
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                Author and article information

                Contributors
                margit.alt-murphy@neuro.gu.se
                c.a.resteghini@uel.ac.uk
                peter.feys@uhasselt.be
                ilse.lamers@uhasselt.be
                Journal
                BMC Neurol
                BMC Neurol
                BMC Neurology
                BioMed Central (London )
                1471-2377
                11 March 2015
                11 March 2015
                2015
                : 15
                : 29
                Affiliations
                [ ]Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3tr, S- 413 45 Göteborg, Sweden
                [ ]School of Health, Sport and Bioscience, University of East London, London, UK
                [ ]REVAL—Rehabilitation Research Centre, BIOMED—Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
                Article
                292
                10.1186/s12883-015-0292-6
                4359448
                25880033
                6ccf784b-977b-4b35-bbf4-f5d795f2793a
                © Alt Murphy et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 November 2014
                : 25 February 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Neurology
                upper limb,psychometrics,rehabilitation,outcome assessment (health care) outcome measures,review

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