Silvia Salvalaggio (IRCCS San Camillo Hospital, Venice, Italy)
Simone Gambazza (University of Milan, Italy)
Silvia Gianola (IRCCS Istituto Ortopedico Galeazzi, Milan, Italy)
Greta Castellini (IRCCS Istituto Ortopedico Galeazzi, Milan, Italy)
Luisa Cacciante (IRCCS San Camillo Hospital, Venice, Italy)
Gianluca Ossola (Aulss 3, Venice, Italy)
Martina Andò (Fondazione Don Gnocchi, Roma, Italy)
Marco Zorzi (University of Padova, Italy)
Andrea Turolla (University of Bologna, Italy)
Upper limb (UL) motor impairment is common among people with stroke (PwS). Previous attempts to develop models predicting UL motor recovery have faced methodological challenges, such as overlooking rehabilitation interventions or inadequate prediction capabilities. This study investigated the association between rehabilitation dose and UL function recovery, using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), across various rehabilitation modalities (Priming, Augmenting, Task-oriented) and stroke phases.
This is a cross-sectional-meta-research study of longitudinal-single-cohort observational-studies within a systematic-review on predictive factors of UL recovery. Selection criteria included adult PwS undergoing UL rehabilitation with FMA-UE as primary outcome. Individual patient data, including rehabilitation dose, pre-and-post-rehabilitation FMA-UE scores, and stroke phase, were extracted. Studies were categorized by rehabilitation modality. A semiparametric-ordinal-regression model was fitted to assess the association between FMA-UE scores and covariates, validated through bootstrapping.
Fifty-four studies encompassing 13774 records were included. The model, incorporating dose, phase, modality, baseline FMA-UE, and dose-phase interaction, was statistically significant (χ2=837.7, p<0.001). Baseline FMA-UE and treatment modality were associated with higher FMA-UE scores. Beyond 40 hours of rehabilitation, increased dose showed minimal changes. Task-oriented rehabilitation yielded the highest probability of achieving notable to full UL function, especially in chronic phases.
Task-oriented rehabilitation is crucial for enhancing UL motor outcomes in PwS, offering significant recovery chances. Efforts to optimize rehabilitation should prioritize Task-oriented interventions, preferably up to 40 hours, during subacute and chronic phases. Future research should comprehensively assess motor impairment and other relevant factors to better understand treatment effects on diverse stroke phenotypes.
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