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 (1) develop a longitudinal mixture model of FM-UE recovery, (2) identify FM-UE recovery subgroups, and (3) internally validate the model predictions. METHODS We developed an exponential recovery function with the following parameters: subgroup assignment probability, proportional recovery coefficient rk , time constant in weeks τk , 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 five subgroups with different recovery parameters (r1  = 0.09, τ1  = 5.3, r2  = 0.46, τ2  = 10.1, r3  = 0.86, τ3  = 9.8, r4  = 0.89, τ4  = 2.7, r5  = 0.93, τ5  = 1.2). Endpoint FM-UE was predicted with a median absolute error of 4.8 IQR=[1.3 12.8] at one week post stroke and 4.2 IQR=[1.3 9.8] at two weeks. Overall accuracy of assignment to the poor (subgroup one), moderate (subgroups two and three) and good (subgroups four and five) FM-UE recovery clusters was 0.79 95%ETI=[0.78 0.80] at one week post stroke and 0.81 95%ETI=[0.80 0.82] at two 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 six months after stroke. This article is protected by copyright. All rights reserved.
Original languageEnglish
Number of pages11
JournalAnnals of Neurology
Issue number3
Publication statusPublished - 10 Jan 2020

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