Predicting upper limb motor impairment recovery after stroke: a mixture model

Rick Vliet, Ruud W. Selles, Eleni‐Rosalina Andrinopoulou, Rinske Nijland, Gerard M. Ribbers, Maarten A. Frens, Carel Meskers, Gert Kwakkel

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Objective: Spontaneous recovery is an important determinant of upper extremity recovery after stroke and has been described by the 70% proportional recovery rule for the Fugl–Meyer motor upper extremity (FM-UE) scale. However, this rule is criticized for overestimating the predictability of FM-UE recovery. Our objectives were to develop a longitudinal mixture model of FM-UE recovery, identify FM-UE recovery subgroups, and internally validate the model predictions. Methods: We developed an exponential recovery function with the following parameters: subgroup assignment probability, proportional recovery coefficient r k, time constant in weeks τ k, and distribution of the initial FM-UE scores. We fitted the model to FM-UE measurements of 412 first-ever ischemic stroke patients and cross-validated endpoint predictions and FM-UE recovery cluster assignment. Results: The model distinguished 5 subgroups with different recovery parameters (r 1 = 0.09, τ 1 = 5.3, r 2 = 0.46, τ 2 = 10.1, r 3 = 0.86, τ 3 = 9.8, r 4 = 0.89, τ 4 = 2.7, r 5 = 0.93, τ 5 = 1.2). Endpoint FM-UE was predicted with a median absolute error of 4.8 (interquartile range [IQR] = 1.3–12.8) at 1 week poststroke and 4.2 (IQR = 1.3–9.8) at 2 weeks. Overall accuracy of assignment to the poor (subgroup 1), moderate (subgroups 2 and 3), and good (subgroups 4 and 5) FM-UE recovery clusters was 0.79 (95% equal-tailed interval [ETI] = 0.78–0.80) at 1 week poststroke and 0.81 (95% ETI = 0.80–0.82) at 2 weeks. Interpretation: FM-UE recovery reflects different subgroups, each with its own recovery profile. Cross-validation indicates that FM-UE endpoints and FM-UE recovery clusters can be well predicted. Results will contribute to the understanding of upper limb recovery patterns in the first 6 months after stroke. ANN NEUROL 2020;87:383–393 Ann Neurol 2020;87:383–393.

Original languageEnglish
Pages (from-to)383-393
Number of pages11
JournalAnnals of Neurology
Issue number3
Publication statusPublished - 1 Mar 2020

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