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Accuracy of physical and occupational therapists' early predictions of recovery after severe middle cerebral artery stroke

Department of Physical Therapy, University Hospital Vrije Universiteit and Research Institute for Fundamental and Clinical Human Movement Sciences, Amsterdam

Gabriella M van Dijk

Centre for Nutritional and Rehabilitation Sciences, University Hospital Utrecht, Utrecht, The Netherlands

Robert C Wagenaar

Sargent College of Health and Rehabilitation Sciences, Department of Physical Therapy, Boston University, Boston, MA, USA

Methods: Within the second and fifth week after stroke onset, 364 predictions were made by 59 PTs and 47 OTs about walking ability, dexterity, activities of daily living (ADL), need for additional care in ADL, time required to achieve independent walking ability and maximal level of ADL, and destination of discharge at six months after stroke. The functional recovery patterns of stroke patients were assessed by an independent observer. The accuracy of the therapists' predictions was compared with that of derived prediction models. In addition, the influence of characteristics of patients and therapists on the accuracy of the predictions was investigated.

Results: Compared to observed outcomes at six months after stroke, therapists' lowest accuracies of prediction were found for the moment at which maximal ADL score was achieved (r_s = 0.07; p = NS), and highest accuracy was for level of dexterity of the hemiplegic arm (r_s = 0.78; p <0.01). Therapists' predictions of functional outcome at six months tended to be too pessimistic. No significant differences were observed for dexterity and walking ability when the predictions by PTs and OTs were compared with those of regression models, whereas significant differences were found for the accuracies of OTs and PTs’ first prediction of destination of discharge and second predictions of outcome in ADL and need for additional care in ADL. No significant differences were found between the accuracy of PTs' and OTs' predictions, and their ability to predict functional outcome was not significantly influenced by the characteristics of patient and therapists.

Conclusions: At two and five weeks after stroke, OTs and PTs can accurately predict level of walking ability and dexterity at six months. The prediction of time required for achieving maximal level of recovery, destination of discharge, outcome of ADL as well as need for additional care in ADL leaves room for improvement.

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				G Kwakkel, B J Kollen, and R C Wagenaar Long term effects of intensity of upper and lower limb training after stroke: a randomised trial J. Neurol. Neurosurg. Psychiatry, April 1, 2002; 72(4): 473 - 479. [Abstract] [Full Text] [PDF]