Self-assessment of stroke recovery correlates with neurologic evaluation
Recent studies have emphasized the utility of patient self-assessments in measuring stroke recovery. We explored the validity of two such methods by comparing patient self-assessments with standard neurologic evaluations. Patients with an ischemic stroke were asked to rate stroke-affected arm use for 10 motor tasks, from Motor Activity Log (MAL). Next, each was asked to rate difficulty in using the stroke-affected hand for the 5 hand function tasks from the Stroke Impact Scale (SIS). Neurological exam was performed, then scoring on NIH Stroke Scale, arm motor Fugl-Meyer scale, and, for each arm, Purdue Pegboard test. Self-assessments were compared with neurologic evaluations using Spearman rank correlation test. Thirty three patients were studied, with mean age 63 years and mean time post-stroke 80 days. Of these, 13 reported no hand use and 5 reported full return of hand use to pre-stroke levels; correlations were performed with and without these 18 patients. Correlations with these patients were consistently stronger than without. However, self-assessment is of greatest interest in patients with intermediate scores, so correlations are reported only for this group (n=15). MAL correlated significantly (p<.01) with strength in several muscles including hand interossei (r=.83), but not deltoid or leg muscles. MAL correlated with NIH score (r=-.76) and Fugl-Meyer score (r=.85), as well as # pegs placed by the paretic hand in 30 seconds (r=.86); but not with index finger proprioception, level of any deep tendon reflex, or # pegs placed by the non-stroke hand. Among patients with intermediate SIS values (n=14), SIS correlated with paretic finger proprioception and strength, arm tone, and # pegs placed (r=.63-.81, p<.05) but not reflexes. MAL and SIS inter-correlated well (r=.91). MAL and SIS show concurrent validity with standard neurologic tests, and correlated more closely with motor evaluations as compared to sensory, strength as compared to deep tendon reflexes, arm evaluations as compared to leg, and hand evaluations as compared to shoulder. These observations are consistent with MAL and SIS content. MAL and SIS are rapid, valid methods for assessing motor status after stroke.