Background and Purpose:
The upper extremity (UE) ipsilateral to the brain lesion is mildly affected poststroke. It is unclear whether patients perceive this, and the association between less-affected hand function and independence in activities of daily living (ADL) is unknown. We aimed to (1) assess longitudinal changes in function, dexterity, grip strength, and self-perception of the less-affected UE, (2) compare them to the normative data, and (3) determine the association of both UEs to ADL during the first 6 months poststroke.
Methods:
Consecutive adults following a first stroke were assessed on rehabilitation admission (T1), 6 weeks (T2), and 6 months (T3) poststroke onset. Box and block test assessed function of both UEs. The functional dexterity test (FDT) and Jamar Dynamometer assessed dexterity and grip strength of the less-affected UE. The functional independence measure assessed ADL, and instrumental ADL was assessed at T3. Spearman correlations and multiple regression models were used.
Results:
Participants were assessed at T1 (N=87), T2 (N=82), and T3 (N=68). At T1, less-affected UE deficits were apparent (median [interquartile range] box and block test-45 [35–53] blocks, FDT-44.5 [33.3–60.8] seconds, grip-25.5 [16.2–33.9] kilograms), but only 19.5% of the participants self-perceived this. Less-affected hand function significantly improved with 32% and 33% achieving a minimal clinically important difference for box and block test at T2 and T3, respectively. Dexterity improved significantly between T1 and T2 (
P
<0.001, no established minimal clinically important difference) and grip strength improved significantly between T2 and T3; 3.4% achieving a minimal clinically important difference (
P
<0.01). At T3, most participants did not reach the norms (box and block test-67.4 blocks, FDT-32.2 seconds, grip-40.5 kilograms). Both the less- and more-affected UEs explained a large portion of the variance of ADL at all time-points, after controlling for age, days-since-stroke-onset, stroke type, and cognition.
Conclusions:
Despite some improvement, the less-affected UE at 6 months poststroke remained below norms, explaining difficulties in ADL and instrumental ADL. Further research is needed.
Determining the minimal clinically important difference of the hand function sort questionnaire in vocational rehabilitation