Factors Influencing Paretic Upper Limb Use During First 4 Weeks After Stroke A Cross-Sectional Accelerometry Study

Objective This study aimed to investigate factors related to paretic upper limb use within the first 4 wks after stroke. Design Sixty inpatients within 4 wks of first-time stroke were stratified by severity defined by Fugl-Meyer Upper Limb scores: severe = 0-22, moderate = 23-50, and mild = 51-66. All wore a wrist accelerometer on the paretic upper limb (24 hrs). Factors investigated were the following measures: upper limb motor impairment; mobility; balance; functional independence; sensory impairment; cognitive function; social factors; environmental restriction; and knowledge. Individual and multivariate quantile regression analyses were performed. Results Upper limb motor impairment, mobility, balance, functional independence, self-efficacy, and knowing how to use the paretic upper limb were significantly related to upper limb use across the three impairment groups (pseudo R-2 = 0.079-0.492, P < 0.02). Multivariate regression showed the only significant factor in moderate and mild group was Fugl-Meyer Upper Limb score (moderate pseudo R-2 = 0.55, mild pseudo R-2 = 0.54, P < 0.001). For the severe group, Fugl-Meyer upper limb score and step count were significant (severe pseudo R-2 = 0.47, P <= 0.030). Conclusions Upper limb motor impairment is significantly associated with paretic upper limb use across three impairment groups and step count with the severe group. Strategies to improve upper limb motor impairment and increase mobility may be required to increase upper limb use.

Automated summary

This study aimed to investigate factors related to paretic upper limb use within the first 4 weeks after stroke. Factors such as upper limb motor impairment, mobility, balance, functional independence, self-efficacy, and knowledge on how to use the paretic upper limb were found to be significantly related to upper limb use. The study also showed that step count was significant in the severe group, suggesting strategies to improve upper limb motor impairment and increase mobility may be required to increase upper limb use.