Scientific article
Open access

Recovery after stroke : the severely impaired are a distinct group

Published inJournal of neurology, neurosurgery and psychiatry, vol. 93, no. 4, p. 369-378
Publication date2022-04
First online date2021-12-22

Introduction: Stroke causes different levels of impairment and the degree of recovery varies greatly between patients. The majority of recovery studies are biased towards patients with mild-to-moderate impairments, challenging a unified recovery process framework. Our aim was to develop a statistical framework to analyse recovery patterns in patients with severe and non-severe initial impairment and concurrently investigate whether they recovered differently.

Methods: We designed a Bayesian hierarchical model to estimate 3-6 months upper limb Fugl-Meyer (FM) scores after stroke. When focusing on the explanation of recovery patterns, we addressed confounds affecting previous recovery studies and considered patients with FM-initial scores <45 only. We systematically explored different FM-breakpoints between severe/non-severe patients (FM-initial=5-30). In model comparisons, we evaluated whether impairment-level-specific recovery patterns indeed existed. Finally, we estimated the out-of-sample prediction performance for patients across the entire initial impairment range.

Results: Recovery data was assembled from eight patient cohorts (n=489). Data were best modelled by incorporating two subgroups (breakpoint:FM-initial=10). Both subgroups recovered a comparable constant amount, but with different proportional components: severely affected patients recovered more the smaller their impairment, while non-severely affected patients recovered more the larger their initial impairment. Prediction of 3-6 months outcomes could be done with an R2=63.5% (95% CI=51.4% to 75.5%).

Conclusions: Our work highlights the benefit of simultaneously modelling recovery of severely-to-non-severely impaired patients and demonstrates both shared and distinct recovery patterns. Our findings provide evidence that the severe/non-severe subdivision in recovery modelling is not an artefact of previous confounds. The presented out-of-sample prediction performance may serve as benchmark to evaluate promising biomarkers of stroke recovery.

  • Cerebrovascular disease
  • Rehabilitation
  • Statistics
  • Stroke
  • Bayes Theorem
  • Humans
  • Recovery of Function
  • Stroke Rehabilitation
  • Upper Extremity
Citation (ISO format)
BONKHOFF, Anna K et al. Recovery after stroke : the severely impaired are a distinct group. In: Journal of neurology, neurosurgery and psychiatry, 2022, vol. 93, n° 4, p. 369–378. doi: 10.1136/jnnp-2021-327211
Main files (1)
Article (Accepted version)
ISSN of the journal0022-3050

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