Revisiting the Proportional Recovery Model in View of the Ceiling Effect of Fugl-Meyer Assessment
- 주제(키워드) brain ischemia , ischemic stroke , medical records , rehabilitation , upper extremity
- 주제(기타) Clinical Neurology; Peripheral Vascular Disease
- 설명문(일반) [Lee, Hyun Haeng; Lee, Jongmin] Konkuk Univ, Sch Med, Med Ctr, Dept Rehabil Med, Seoul, South Korea; [Kim, Deog Young] Yonsei Univ, Coll Med, Res Inst Rehabil Med, Seoul, South Korea; [Kim, Deog Young] Yonsei Univ, Coll Med, Dept, Seoul, South Korea; [Sohn, Min Kyun] Chungnam Natl Univ, Sch Med, Dept Rehabil Med, Daejeon, South Korea; [Shin, Yong-Il] Pusan Natl Univ, Yangsan Hosp, Sch Med, Dept Rehabil Med, Pusan, South Korea; [Oh, Gyung-Jae] Wonkwang Univ, Sch Med, Dept Prevent Med, Iksan, South Korea; [Joo, Min Cheol] Wonkwang Univ, Sch Med, Dept Rehabil Med, Iksan, South Korea; [Lee, Yang-Soo] Kyungpook Natl Univ, Kyungpook Natl Univ Hosp, Sch Med, Dept Rehabil Med, Daegu, South Korea; [Lee, Yang-Soo] Jeju Natl Univ, Sch Med, Jeju Natl Univ Hosp, Dept Rehabil Med, Jeju, South Korea; [Han, Junhee] Hallym Univ, Inst Stat, Chunchon, South Korea; [Han, Junhee] Hallym Univ, Dept Stat, Chunchon, South Korea; [Ahn, Jeonghoon] Ewha Womans Univ, Dept Hlth Convergence, Seoul, South Korea; [Chang, Won Hyuk; Kim, Yun-Hee] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Heart Vasc Stroke Inst,Dept Phys & Rehabil Med, Irwon Ro 115, Seoul 06355, South Korea; [Kim, Ilyoel; Mi Choi, Soo] Korea Ctr Dis Control & Prevent, Ctr Dis, Div Chron Dis Prevent, Cheongju, South Korea; [Kim, Yun-Hee] Sungkyunkwan Univ, SAIHST, Dept Med Device Management & Res, Dept Digital Hlth,Dept Hlth Sci & Technol, Irwon Ro 115, Seoul 06355, South Korea
- 등재 SCIE, SCOPUS
- OA유형 Bronze
- 발행기관 LIPPINCOTT WILLIAMS & WILKINS
- 발행년도 2021
- URI http://www.dcollection.net/handler/ewha/000000183616
- 본문언어 영어
- Published As http://dx.doi.org/10.1161/STROKEAHA.120.032409
- PubMed https://pubmed.ncbi.nlm.nih.gov/34134508
초록/요약
Background and Purpose: The aim of this study was to verify the validity of the proportional recovery model in view of the ceiling effect of the Fugl-Meyer Assessment. Methods: We reviewed the medical records of patients enrolled in the Korean Stroke Cohort for Functioning and Rehabilitation between August 2012 and May 2015. Recovery proportion was defined as the actual change in Fugl-Meyer Assessment score of the upper extremity between 7 days and 6 months poststroke, relative to the initial neurological impairment. We then used logistic regression to identify clinical factors attributable to a ceiling effect of the Fugl-Meyer Assessment score of the upper extremity and propensity score matching to verify the validity of the proportional recovery rule. Results: We screened 10 636 patients and analyzed 849 patients (mean age, 65.4 +/- 11.9 years; female, 320 [37.7%]) with first-ever ischemic stroke. We found, through logistic regression analysis, that a one-unit increase in the initial neurological impairment and the age at stroke onset affected the odds ratio (1.0386 and 0.9736, respectively) of achieving the full Fugl-Meyer Assessment score of the upper limb at 6 months poststroke. We also demonstrated, through propensity score matching, that the difference in initial neurological impairment of the upper extremity resulted in discrepancy of the recovery proportion (0.92 +/- 0.20 [0-1] versus 0.81 +/- 0.31 [0-1], P<0.001). Conclusions: We demonstrated that the ceiling effect of the Fugl-Meyer Assessment score of the upper extremity is pronounced in patients with mild initial motor deficits of the upper extremity and that the recovery proportion varies according to the initial motor deficit of the upper limb using logistic regression analysis and propensity score matching, respectively. These results suggest that the proportional recovery model is not valid.
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