Predicting daily use of the affected upper extremity 1 year after stroke

Background: The ultimate goal of upper extremity (UE) stroke rehabilitation is for the individual with stroke to return using their arms and hands during daily activities in their own environment. No studies have monitored arm use as individuals with stroke transition from rehabilitation to the home setting. This longitudinal study compared the functional ability and daily use of the affected UE of individuals with stroke between discharge to home and 12 months after stroke and predicted the UE daily use 12 months after stroke.

Methods: Participants were assessed on discharge to home from rehabilitation and at 12 months after stroke. UE daily use was measured by wrist accelerometers and self-report by the Motor Activity Log (MAL). Multivariate logistic regression models were used to predict UE daily use 12 months after stroke.

Results: The UE functional ability improved significantly from discharge to 12 months after stroke. The amount of self-report UE daily use significantly improved (z = -2.9, P = .004), but accelerometer activity counts did not (z = -0.15, P = .88), and the daily use of the nonaffected UE was 3 times more than the affected UE. After controlling for age and accelerometer daily use on discharge, UE variables of movement, function, dexterity, and strength accounted for an additional 10.9%-13.6% of the variance for accelerometer readings. After controlling for gender and MAL daily use on discharge, UE variables accounted for an additional 7%-12% of the variance for the MAL.

Conclusions: UE daily use 12 months after stroke is very limited despite the motor and functional improvement. Enhanced motor and functional ability at discharge predicts more UE daily use at 12 months after stroke. Interventions that monitor and encourage these individuals to use their UE are required to ensure that functional gains translate to daily use.