Can stroke survivors with severe upper arm disability achieve a clinically important change in arm function during inpatient rehabilitation? A multicentre, prospective, observational study

BACKGROUND: Severe arm disability is considered to indicate poor potential to recover arm function. OBJECTIVE: Determine if stroke survivors with severe upper arm disability can achieve a clinically important change in arm function on discharge from inpatient rehabilitation. METHODS: 618 stroke survivors from 16 inpatient rehabilitation units were assessed on admission and discharge using the Motor Assessment Scale Item 6 Upper Arm Function (MAS6). Admission scores defined participants with severe (MAS6 <= 2) and mild/moderate (MAS6 >2) upper arm disability. A clinically important change was evaluated according to: 1) statistical significance; 2) minimal clinical importance difference (MCID); and 3) shift in disability status i.e., severe to mild/moderate. Achievers of a MCID and shift were compared to non-achievers. RESULTS: Stroke survivors with severe upper arm disability (n = 226) demonstrated a significant improvement in arm function (p < 0.001) at discharge. A MCID was achieved by 68% (n = 155) and a shift from severe to mild/moderate upper arm disability on discharge by 45%(n = 102) of participants. Achievers had a significantly shorter interval from stroke onset to inpatient rehabilitation admission (p < 0.002). CONCLUSION: Stroke survivors with severe upper arm disability can achieve a clinically important change during inpatient rehabilitation.