Match and mismatch between objective and subjective improvements in upper limb function after stroke

Purpose: To identify stroke patients showing a match between an objectively meaningful improvement in upper-limb motor capacity and subjectively meaningful improvement in pper-limb performance after stroke, as well as determinants of matching and non-matching.

Methods: Changes in upper-limb capacity in 39 stroke patients were measured over 17 weeks
using the Action Research Arm Test (ARAT). Subjective change was measured with the Stroke Impact Scale Hand domain (SIS-Hand) and the Motor Activity Log (MAL). Patients showing a match between objective and subjective improvements (matchers) and patients showing a mismatch (non-matchers) were identified. Subsequently, determinants for the matchers were modeled using a logistic regression analysis. Results: A significant association was found between improvements on the ARAT and MAL (p¼0.011), but not for improvements on the
ARAT and SIS-Hand. For the ARAT and SIS-Hand level of education and mood significantly improved the model. The probability of a match between objective and subjective outcomes in lower-educated patients with a positive mood was estimated to be 0.83, whereas in higher educated patients with a negative mood it was estimated to be 0.07.

Conclusions: Mismatches between objective and subjective outcomes are relevant for practitioners evaluating rehabilitation goals, and for defining outcome variables in future upper limb rehabilitation trials.