Stroke, Vol 23, 1084-1089, Copyright © 1992 by American Heart Association
PW Duncan, LB Goldstein, D Matchar, GW Divine and J Feussner
BACKGROUND AND PURPOSE: The purpose of this study was to analyze recovery
of motor function in a cohort of patients presenting with an acute
occlusion in the carotid distribution. Analysis of recovery patterns is
important for estimating patient care needs, establishing therapeutic
plans, and estimating sample sizes for clinical intervention trials.
METHODS: We prospectively measured the motor deficits of 104 stroke
patients over a 6-month period to identify earliest measures that would
predict subsequent motor recovery. Motor function was measured with the
Fugl-Meyer Assessment. Fifty-four patients were randomly assigned to a
training set for model development; 50 patients were assigned to a test set
for model validation. In a second analysis, patients were stratified on
basis of time and stroke severity. The sample size required to detect a 50%
improvement in residual motor function was calculated for each level of
impairment and at three points in time. RESULTS: At baseline the initial
Fugl-Meyer motor scores accounted for only half the variance in 6-month
motor function (r2 = 0.53, p less than 0.001). After 5 days, both the 5-day
motor and sensory scores explained 74% of the variance (p less than 0.001).
After 30 days, the 30-day motor score explained 86% of the variance (p less
than 0.001). Application of these best models to the test set confirmed the
results obtained with the training set. Sample-size calculations revealed
that as severity and time since stroke increased, sample sizes required to
detect a 50% improvement in residual motor deficits decreased. CONCLUSIONS:
Most of the variability in motor recovery can be explained by 30 days after
stroke. These findings have important implications for clinical practice
and research.
ARTICLES
Measurement of motor recovery after stroke. Outcome assessment and sample size requirements
Graduate Program in Physical Therapy, Durham Veterans Administration, N.C.
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