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A cross sectional study of upper extremity strength ten days after a stroke; relationship between patient-reported and objective measures.

Persson HC, Danielsson A, Sunnerhagen KS - BMC Neurol (2015)

Bottom Line: In SIS 1a and 1b, 1-3 points correspond to reduced strength (<80% or normative strength values).The correlation between the measured strength values and perceived arm strength was rho 0.82 (p =  <0.001) and with perceived grip strength rho 0.87 (p = <0.001).Using the dichotomized SIS and the 80% cut-off correctly classified arm strength in 81% and grip strength in 84% of the patients, with a sensitivity of 0.86-0.87, a specificity of 0.62-0.77, positive predicted values of 0.87-0.91 and negative predicated values of 0.64-0.67.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. hanna.persson@neuro.gu.se.

ABSTRACT

Background: Reduced upper extremity function early after a stroke is common, and a combination of strength capacity and patient-reported measures contribute to setting realistic goals. The validity of the patient's perception of upper extremity strength in relation to objective strength assessments early after a stroke needs to be clarified. The objective was to investigate the relationship between perceived upper extremity strength and measured hand strength at ten days post-stroke.

Methods: This study of 99 patients with reduced upper extremity function at 3 days post stroke, were consecutively included from a stroke unit to the Stroke Arm Longitudinal Study at the University of Gothenburg, (the SALGOT-study). The correlations between two questions from the Stroke Impact Scale (SIS 1a and 1b), and a dynamometer measure of hand strength values (percentage of normative values) were investigated. In order to explain differences between the two types of measurements, the accordance between perceived strength in a dichotomized SIS and objective measures was explored. In SIS 1a and 1b, 1-3 points correspond to reduced strength (<80% or normative strength values). In SIS 1a and 1b, 4-5 points correspond to normal strength (≥ 80% of normative strength values).

Results: The correlation between the measured strength values and perceived arm strength was rho 0.82 (p =  <0.001) and with perceived grip strength rho 0.87 (p = <0.001). Using the dichotomized SIS and the 80% cut-off correctly classified arm strength in 81% and grip strength in 84% of the patients, with a sensitivity of 0.86-0.87, a specificity of 0.62-0.77, positive predicted values of 0.87-0.91 and negative predicated values of 0.64-0.67.

Discussion: The discrepancy between assessed strength capacity and self-perceived strength highlights the importance of including self-perceived assessments early after stroke, in order to increase knowledge of a patient's awareness of functioning or lack thereof.

Conclusions: Ten days after stroke in patients without severe cognitive disabilities, this study suggests that despite high correlations between measures, an objective assessment of arm and hand strength does not always reflect the patient's perspective. A combination of self-reported and objective strength assessment is requested to enhance in setting of realistic goals early after stroke.

Trial registration: ClinicalTrials.gov: NCT01115348, May 3, 2010.

No MeSH data available.


Related in: MedlinePlus

Objective strength at different levels of perceived strength in the paretic arm and hand. a illustrates objective strength (percentages of normative dynamometer strength values) in relation to self-reported arm strength. b illustrates the objective strength in the relation to self-reported hand strength. Abbreviations: Dynamometer; JAMAR Hand Dynamometer; SIS, Stroke Impact Scale questions 1A and 1B
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Fig1: Objective strength at different levels of perceived strength in the paretic arm and hand. a illustrates objective strength (percentages of normative dynamometer strength values) in relation to self-reported arm strength. b illustrates the objective strength in the relation to self-reported hand strength. Abbreviations: Dynamometer; JAMAR Hand Dynamometer; SIS, Stroke Impact Scale questions 1A and 1B

Mentions: Demographical data are given in Table 1. Fifty-seven percent were men, and the mean age at stroke onset was 67.4 years. The average of normative strength values at ten days after stroke, assessed with dynamometer, was less than 50 %. Few patients had reduced ability to participate in the test situation or had cognitive defects assessed with screening tests. Figure 1 illustrates the different levels of perceived strength (SIS) in relation to the objective strength measure expressed as a percentage of normative values ten days post-stroke. As shown, perceived strength (SIS) for arm and hand grip were similar (Fig. 1a and b). The widest disparities were found in the categories a little strength (2 points) and some strength (3 p). Please note that the category a lot of strength (5 points) was rated by only 5 (SIS 1a) and 4 (SIS 1b) patients, respectively. The correlations between the measured (percentage of normative strength values) and perceived arm (SIS 1a) and hand grip (SIS 1b) strength were rho 0.82 (p = <0.001) and rho 0.87 (p = <0.001), respectively.Table 1


A cross sectional study of upper extremity strength ten days after a stroke; relationship between patient-reported and objective measures.

Persson HC, Danielsson A, Sunnerhagen KS - BMC Neurol (2015)

Objective strength at different levels of perceived strength in the paretic arm and hand. a illustrates objective strength (percentages of normative dynamometer strength values) in relation to self-reported arm strength. b illustrates the objective strength in the relation to self-reported hand strength. Abbreviations: Dynamometer; JAMAR Hand Dynamometer; SIS, Stroke Impact Scale questions 1A and 1B
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4591668&req=5

Fig1: Objective strength at different levels of perceived strength in the paretic arm and hand. a illustrates objective strength (percentages of normative dynamometer strength values) in relation to self-reported arm strength. b illustrates the objective strength in the relation to self-reported hand strength. Abbreviations: Dynamometer; JAMAR Hand Dynamometer; SIS, Stroke Impact Scale questions 1A and 1B
Mentions: Demographical data are given in Table 1. Fifty-seven percent were men, and the mean age at stroke onset was 67.4 years. The average of normative strength values at ten days after stroke, assessed with dynamometer, was less than 50 %. Few patients had reduced ability to participate in the test situation or had cognitive defects assessed with screening tests. Figure 1 illustrates the different levels of perceived strength (SIS) in relation to the objective strength measure expressed as a percentage of normative values ten days post-stroke. As shown, perceived strength (SIS) for arm and hand grip were similar (Fig. 1a and b). The widest disparities were found in the categories a little strength (2 points) and some strength (3 p). Please note that the category a lot of strength (5 points) was rated by only 5 (SIS 1a) and 4 (SIS 1b) patients, respectively. The correlations between the measured (percentage of normative strength values) and perceived arm (SIS 1a) and hand grip (SIS 1b) strength were rho 0.82 (p = <0.001) and rho 0.87 (p = <0.001), respectively.Table 1

Bottom Line: In SIS 1a and 1b, 1-3 points correspond to reduced strength (<80% or normative strength values).The correlation between the measured strength values and perceived arm strength was rho 0.82 (p =  <0.001) and with perceived grip strength rho 0.87 (p = <0.001).Using the dichotomized SIS and the 80% cut-off correctly classified arm strength in 81% and grip strength in 84% of the patients, with a sensitivity of 0.86-0.87, a specificity of 0.62-0.77, positive predicted values of 0.87-0.91 and negative predicated values of 0.64-0.67.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. hanna.persson@neuro.gu.se.

ABSTRACT

Background: Reduced upper extremity function early after a stroke is common, and a combination of strength capacity and patient-reported measures contribute to setting realistic goals. The validity of the patient's perception of upper extremity strength in relation to objective strength assessments early after a stroke needs to be clarified. The objective was to investigate the relationship between perceived upper extremity strength and measured hand strength at ten days post-stroke.

Methods: This study of 99 patients with reduced upper extremity function at 3 days post stroke, were consecutively included from a stroke unit to the Stroke Arm Longitudinal Study at the University of Gothenburg, (the SALGOT-study). The correlations between two questions from the Stroke Impact Scale (SIS 1a and 1b), and a dynamometer measure of hand strength values (percentage of normative values) were investigated. In order to explain differences between the two types of measurements, the accordance between perceived strength in a dichotomized SIS and objective measures was explored. In SIS 1a and 1b, 1-3 points correspond to reduced strength (<80% or normative strength values). In SIS 1a and 1b, 4-5 points correspond to normal strength (≥ 80% of normative strength values).

Results: The correlation between the measured strength values and perceived arm strength was rho 0.82 (p =  <0.001) and with perceived grip strength rho 0.87 (p = <0.001). Using the dichotomized SIS and the 80% cut-off correctly classified arm strength in 81% and grip strength in 84% of the patients, with a sensitivity of 0.86-0.87, a specificity of 0.62-0.77, positive predicted values of 0.87-0.91 and negative predicated values of 0.64-0.67.

Discussion: The discrepancy between assessed strength capacity and self-perceived strength highlights the importance of including self-perceived assessments early after stroke, in order to increase knowledge of a patient's awareness of functioning or lack thereof.

Conclusions: Ten days after stroke in patients without severe cognitive disabilities, this study suggests that despite high correlations between measures, an objective assessment of arm and hand strength does not always reflect the patient's perspective. A combination of self-reported and objective strength assessment is requested to enhance in setting of realistic goals early after stroke.

Trial registration: ClinicalTrials.gov: NCT01115348, May 3, 2010.

No MeSH data available.


Related in: MedlinePlus