van der Vliet et al (Accepted manuscript) Predicting upper limb motor impairment recovery after stroke: a mixture model. Annals of Neurology, https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.25679
This is the first time I’ve referenced an article that’s still being edited! Be assured it’s been accepted by the journal, but it’s sooo.. recent, that it’s not even “in press” yet!
Acknowledging that this article comes out of Gert Kwakkel’s research team, it’s yet more confirmation that upper limb recovery after stroke can be predicted in most affected people, most of the time. And that’s what evidence is all about – it’s about predicting patterns across populations. Sure, there’ll always be the exceptions, but it’s still important to understand what’s most likely to occur in most patients, most of the time; even if they indicate no improvement in some.
When I read this article, I thought “phew”! As a health professional who’s been presenting evidence on this for some years now, I’ve copped my share of criticism and disbelief. And that’s OK. Essentially, as scientific communities, it’s very important that we’re always prepared to question, challenge and discuss current clinical practice. However, there’s now ample evidence that, most of the time, it’s possible to accurately predict upper limb recovery after stroke in most people, based on data collected in the first week post-event.
As I argue in my Changing Stroke book, accepting this evidence means presenting it to those directly affected, and in turn, offering them interventions influenced by the early data. What I refer to as a stratified approach. Not accepting this evidence means leaving those directly affected, ill-informed, and, by applying a one-size-fits-all approach, potentially spending time engaged in interventions that are highly unlikely to be effective. Were I to have recently experienced a stroke-affected upper limb, I’d want to know what is most likely to occur, and, as with most events in my life, prepare for the worst and hope for the best.
As always, this is just my humble opinion, and you’ll find the full reference and abstract under Journal Club 2020. It’s important to read this article for yourself. Although challenging to read, it’s worth it; particularly the figures which at present, are on the final page of the PdF. Once published, these will be embedded in the article’s results.