Elisabeth Ekstrand

Isometric and isokinetic muscle strength in the upper extremity can be reliably measured in persons with chronic stroke.

OBJECTIVE To evaluate the test-retest reliability of isometric and isokinetic muscle strength measurements in the upper extremity after stroke. DESIGN A test-retest design. SUBJECTS Forty-five persons with mild to moderate paresis in the upper extremity > 6 months post-stroke. METHODS Isometric arm strength (shoulder abduction, elbow flexion), isokinetic arm strength (elbow extension/flexion) and isometric grip strength were measured with electronic dynamometers. Reliability was evaluated with intra-class correlation coefficients (ICC), changes in the mean, standard error of measurements (SEM) and smallest real differences (SRD). RESULTS Reliability was high (ICCs: 0.92-0.97). The absolute and relative (%) SEM ranged from 2.7 Nm (5.6%) to 3.0 Nm (9.4%) for isometric arm strength, 2.6 Nm (7.4%) to 2.9 Nm (12.6%) for isokinetic arm strength, and 22.3 N (7.6%) to 26.4 N (9.2%) for grip strength. The absolute and relative (%) SRD ranged from 7.5 Nm (15.5%) to 8.4 Nm (26.1%) for isometric arm strength, 7.1 Nm (20.6%) to 8.0 Nm (34.8%) for isokinetic arm strength, and 61.8 N (21.0%) to 73.3 N (25.6%) for grip strength. CONCLUSION Muscle strength in the upper extremity can be reliably measured in persons with chronic stroke. Isometric measurements yield smaller measurement errors than isokinetic measurements and might be preferred, but the choice depends on the research question.

THE PHYSIOTHERAPY CLINICAL OUTCOME VARIABLES SCALE PREDICTS LENGTH OF HOSPITAL STAY, DISCHARGE DESTINATION AND FUTURE HOME FACILITY IN THE ACUTE COMPREHENSIVE STROKE UNIT*

OBJECTIVE The aims of this study were: to follow the course of recovery of motor function following acute stroke, as assessed by the Physiotherapy Clinical Outcome Variables Scale (COVS), and; to investigate the ability of this instrument to predict length of hospital stay, discharge destination and future home facility. METHODS In this prospective longitudinal study, COVS was registered at admission and discharge from an acute stroke unit and at 3 months post-stroke onset. SUBJECTS Sixty subjects were recruited consecutively from a sample of patients after first-ever acute stroke, and of these, 50 received follow-up assessment. OUTCOME VARIABLES Length of hospital stay, discharge destination and home facility 3 months post-stroke. RESULTS The overall COVS scores increased significantly during the 3-month follow-up. The admission COVS score correlated negatively with length of stay. A cut-off at 50 points and 41 points could predict discharge destination and future home facility, respectively. CONCLUSION COVS measures improvements and can predict length of hospital stay, discharge destination and future home facility. Thus, it could be used in early prediction for effective planning of the acute stroke unit services and efficient discharge planning.

Somatosensory impairments are common after stroke but have only a small impact on post-stroke shoulder pain.

OBJECTIVE To investigate whether somatosensory impairments are more common in individuals with post-stroke shoulder pain than in those without post-stroke shoulder pain and healthy controls. DESIGN Descriptive analysis of a convenience sample. PARTICIPANTS Forty-nine individuals with stroke, 24 with and 25 without post-stroke shoulder pain (median age 65 years), and 11 age- and sex-matched healthy controls. METHODS Perception and pain thresholds for cold, warm and heat (thermal thresholds), and pain thresholds for pressure and pin prick (mechanical thresholds) were assessed using quantitative sensory testing (QST). Passive range of motion, motor function, resistance to passive movements, light touch and proprioception were assessed in the upper extremities. Shoulder pain characteristics were recorded in the post-stroke shoulder pain group. RESULTS There were no significant differences between the group with post-stroke shoulder pain and the group without post-stroke shoulder pain in any of the QST assessments, but more participants in the post-stroke shoulder pain group reported abnormal cold sensation in the affected side. Both stroke groups had generally higher thermal thresholds and more extreme low or high mechanical thresholds than the healthy controls. CONCLUSION Somatosensory impairments are common among individuals with stroke compared with healthy controls. The non-significant differences in QST thresholds between the group with post-stroke shoulder pain and the group without post-stroke shoulder pain indicate that somatosensory impairments have only a small impact on post-stroke shoulder pain.

Grip strength is a representative measure of muscle weakness in the upper extremity after stroke

Background: Muscle weakness is the most common impairment in the upper extremity after stroke, leading to a reduced ability to use the arm and the hand in daily activities. Grip strength is easier to measure than precise, but more time-consuming, isokinetic and isometric arm muscle strength measurements. It would therefore be advantageous in a clinical setting if grip strength could be used as a proxy for muscle strength in the entire upper extremity. Objective: To investigate the association between grip strength and isometric and isokinetic arm muscle strength in persons with chronic stroke. Methods: Forty-five persons with mild-to-moderate paresis in the upper extremity, at least 6 months post-stroke participated. Isometric grip strength was measured with a computerized grip dynamometer and arm strength (isometric shoulder abduction and elbow flexion as well as isokinetic elbow extension and flexion) with an isokinetic dynamometer. Pearson’s correlation coefficient was used to determine the association between the muscle strength measurements. Results: There were significant correlations (p < .0001) between grip strength and all arm strength measurements in both the more affected (r = 0.77–0.82) and the less affected upper extremity (r = 0.65–0.82). Conclusion: This cross-sectional study showed that grip strength is strongly associated with muscle strength in the arm in persons in the chronic phase after stroke. As grip strength is easy to measure and less time-consuming than arm muscle strength measurements, this implies that grip strength can be a representative measure of muscle weakness of the entire upper extremity in the chronic phase after stroke.

Test−Retest Reliability and Convergent Validity of Three Manual Dexterity Measures in Persons With Chronic Stroke

Decreased manual dexterity is common in persons after stroke. Different measures are used to assess manual dexterity, but a lack of knowledge exists about their reliability and how they are related.

Test-retest reliability of the Shape/Texture Identification testTM in people with chronic stroke

Objective: To evaluate the test-retest reliability of the Shape/Texture Identification test (STI-testTM) in persons with chronic stroke. Design: A test-retest design. Setting: University hospital outpatient setting. Participants: Forty-five persons (mean age 65 years) with mild to moderate impairments in the arm and hand > 6 months post stroke. Interventions: Not applicable. Main measure: The STI-testTM was used to assess active touch of the hand. It consists of two subtests: identification of shapes and identification of textures, each in three different sizes. Both hands were assessed twice, one week apart. The reliability of the data was evaluated with weighted Kappa statistics and the Svensson rank-invariant method (percentage agreement, systematic and random disagreements). Results: The median total score of the STI-testTM was 5 points (min-max 0-6 points) for the more affected hand and 6 points (min-max 3-6 points) for the less affected hand at both test occasions. The weighted Kappa coefficient was 0.94 for the more affected hand and 0.55 for the less affected hand. The percentage agreement for the more affected hand was 69% for the subtest shapes and 82% for the subtest textures, and for the less affected hand 62% and 91%, respectively. There were no systematic or random disagreements for any of the subtests. Conclusion: The STI-testTM is reliable to assess active touch of the hand after stroke.

Measurement variability of quantitative sensory testing in persons with post-stroke shoulder pain.

OBJECTIVE To evaluate the measurement variability of quantitative sensory testing (QST) in persons with post-stroke shoulder pain. DESIGN A test-retest design. PARTICIPANTS Twenty-three persons with post-stroke shoulder pain (median age 65 years). METHODS Thermal detection thresholds (cold and warm), pain thresholds (cold and heat) and mechanical pain thresholds (pressure and pin prick) were assessed twice in both arms, 2-3 weeks apart. Measurement variability was analysed with the intraclass correlation coefficient (ICC2.1), the change in mean (đ) with 95% confidence interval (logarithmic scales), and the relative standard error of measurement (SEM%; re-transformed scales). RESULTS The ICCs for thermal thresholds ranged from 0.48 to 0.89 in the affected (painful) arm and from 0.50 to 0.63 in the unaffected arm, and for mechanical pain thresholds from 0.66 to 0.90 in both arms. No systematic changes in the mean (đ) were found. The SEM% ranged from 4% to 10% for thermal detection and heat pain thresholds, and from 17% to 42% for cold pain and mechanical pain thresholds in both arms. CONCLUSION QST measurements, especially cold pain thresholds and mechanical pain thresholds, vary in persons with post-stroke shoulder pain. Before QST can be used routinely to evaluate post-stroke shoulder pain, a test protocol with decreased variability needs to be developed.

Test-retest reliability of the Participation domain of the Stroke Impact Scale in persons with chronic stroke

OBJECTIVE To evaluate the test-retest reliability and variability of the Participation domain of the Stroke Impact Scale (SIS Participation) in persons with stroke as it is widely used to assess perceived participation in rehabilitation after stroke. DESIGN A test-retest design. SUBJECTS Forty-five persons (mean age 65 years) with mild to moderate disability at least 6 months post-stroke. METHODS The SIS Participation domain was rated on 2 occasions, 1 week apart. The test-retest reliability of the total score was evaluated using Kappa statistics. The 8 item scores were evaluated by the proportion of participants who rated the same score (percentage agreement, PA) or ± 1 point (PA ≤ 1 point) at T1 and T2. The Svensson method was used to evaluate systematic and random disagreement. RESULTS The test-retest reliability of the total score showed excellent agreement (Kappa coefficient = 0.79). The items showed high PA ≤ 1 point (> 82%). No items, except 2, showed a systematic disagreement, and no items showed a random disagreement according to the Svensson method. CONCLUSION The SIS Participation domain is reliable in persons with chronic stroke and mild to moderate disability and can be used to assess perceived participation in this population.

Hospital comparison of stroke care in Sweden : A register-based study

Background and purpose The objective of this study was to estimate the level of health outcomes and resource use at a hospital level during the first year after a stroke, and to identify any potential differences between hospitals after adjusting for patient characteristics (case mix). Method Data from several registries were linked on individual level: seven regional patient administrative systems, Swedish Stroke Register, Statistics Sweden, National Board of Health and Welfare and Swedish Social Insurance Agency. The study population consisted of 14 125 patients presenting with a stroke during 2010. Case-mix adjusted analysis of hospital differences was made on five aspects of health outcomes and resource use, 1 year post-stroke. Results The results indicated that 26% of patients had died within a year of their stroke. Among those who survived, almost 5% had a recurrent stroke and 40% were left with a disability. On average, the patients had 22 inpatient days and 23 outpatient visits, and 13% had moved into special housing. There were significant variations between hospitals in levels of health outcomes achieved and resources used after adjusting for case mix. Conclusion Differences in health outcomes and resource use between hospitals were substantial and not entirely explained by differences in patient mix, indicating tendencies of unequal stroke care in Sweden. Healthcare organisation of regions and other structural features could potentially explain parts of the differences identified.