Recovery from motor paralysis is facilitated by affected patients’ recognition of the need for and practice of their own exercise goals. Neurorehabilitation has been proposed and used for the treatment of motor paralysis in stroke, and its effect has been verified. If an expected score for the neurorehabilitation effect can be calculated using the Fugl-Meyer Motor Assessment (FMA), a global assessment index, before neurorehabilitation, such a score will be useful for optimizing the treatment application criteria and for setting a goal to enhance the treatment effect. Therefore, this study verified whether the responsiveness to a treatment method, the NovEl intervention using repetitive transcranial magnetic stimulation and occupational therapy (NEURO), in patients with post-stroke upper extremity (UE) motor paralysis could be predicted by the pretreatment FMA score. No control group was established in this study for NEURO treatment. To analyze the recovery of the motor function in the UE, delta-FMA was calculated from the pre- and post-FMA scores obtained during NEURO treatment. The probability of three levels of treatment responsiveness was evaluated in association with delta-FMA score (<5, 5 ≤ delta-FMA <10, and ≥10 as non-responders; responders; and hyper-responders, respectively) according to the reported minimal clinically important difference (MCID). The association of the initial FMA scores with post-FMA scores, from the status of the treatment responsiveness, was determined by multinomial logistic regression analysis. Finally, 1,254 patients with stroke, stratified by FMA scores were analyzed. About 45% of the patients who had FMA scores ranging from 30 to 40 before treatment showed improvement over the MCID by NEURO treatment (odds ratio = 0.93, 95% CI = 0.92–0.95). Furthermore, more than 25% of the patients with more severe initial values, ranging from 26 to 30, improved beyond the MCID calculated in the acute phase (odds ratio = 0.87, 95% CI = 0.85–0.89). These results suggest that the evaluated motor function score of the UE before NEURO treatment can be used to estimate the possibility of a patient recovering beyond MCID in the chronic phase. This study provided clinical data to estimate the effect of NEURO treatment by the pretreatment FMA-UE score.
Introduction
Motor paralysis due to the aftereffects of stroke impairs the activities of daily living (ADL) and quality of life (QOL) of patients; it also affects their individual or social activities (1, 2). In particular, motor paralysis of the upper extremity has a large impact on ADL (3). Recovery from motor paralysis is facilitated by patients recognizing the need for and practicing their own exercise goals (4). The type of goals that patients set are related to their goal satisfaction scores, with impairment-based goals being rated significantly higher than activity-based and participation-based goals (5). It is known that patients’ level of knowledge of their rehabilitation goals leads to effective treatment results (6). Thus, clinicians and patients are active partners in setting goals within stroke rehabilitation (5). In previous studies, some prognosis prediction systems were developed for motor paralysis (7–9), and they have been used to set goals for rehabilitation in patients with stroke.
Neurorehabilitation has been proposed and used for the treatment of motor paralysis in stroke, and its effect has been verified (10–14). One of the treatment methods, the NovEl intervention Using Repetitive transcranial magnetic stimulation and Occupational therapy (NEURO), facilitates peripheral muscle movement by controlling the excitability of the motor cortices by repetitive transcranial magnetic stimulation (rTMS). It also promotes peripheral muscle exercise and practice, for the active use of the paralyzed upper extremity (15, 16). NEURO’s efficacy has been proved in a randomized controlled study (17). To date, many patients have been treated by using NEURO; however, the prediction regarding whether patients’ recovery from motor paralysis after treatments can be predicted before treatment, has not been verified. If the Fugl-Meyer Motor Assessment (FMA) score before treatment can be used to predict NEURO treatment response, the score can be used as an effective goal for rehabilitation, by patients and therapists.
The minimal clinically important difference (MCID) of motor paralysis in the upper extremity has been investigated (18–20). If the expected value of an effect exceeding MCID can be calculated using FMA score measured before NEURO treatment, such a value will be useful for optimizing the treatment application criteria and setting a goal to enhance the treatment effect. For that purpose, it is sufficient to retroactively analyze the band of the FMA score before NEURO for a patient who is significantly improved. Therefore, this study verified whether the responsiveness of NEURO treatment for patients with post-stroke upper extremity motor paralysis could be predicted by the pre-treatment FMA score.[…]