May 2017: Stinear CM, Byblow WD, Ackerley SJ, Barber PA, Smith M-C (2017 In Press) Predicting recovery potential for individual stroke patients increases rehabilitation efficiency. Stroke, https://doi.org/10.1161/STROKEAHA.116.015790
Background and Purpose Several clinical measures and biomarkers are associated with motor recovery after stroke, but none are used to guide rehabilitation for individual patients. The objective of this study was to evaluate the implementation of upper limb predictions in stroke rehabilitation, by combining clinical measures and biomarkers using the Predict Recovery Potential (PREP) algorithm.
Methods—Predictions were provided for patients in the implementation group (n=110) and withheld from the comparison group (n=82). Predictions guided rehabilitation therapy focus for patients in the implementation group. The effects of predictive information on clinical practice (length of stay, therapist confidence, therapy content, and dose) were evaluated. Clinical outcomes (upper limb function, impairment and use, independence, and quality of life) were measured 3 and 6 months poststroke. The primary clinical practice outcome was inpatient length of stay. The primary clinical outcome was Action Research Arm Test score 3 months poststroke.
Results—Length of stay was 1 week shorter for the implementation group (11 days; 95% confidence interval, 9–13 days) than the comparison group (17 days; 95% confidence interval, 14–21 days; P=0.001), controlling for upper limb impairment, age, sex, and comorbidities. Therapists were more confident (P=0.004) and modified therapy content according to predictions for the implementation group (P<0.05). The algorithm correctly predicted the primary clinical outcome for 80% of patients in both groups. There were no adverse effects of algorithm implementation on patient outcomes at 3 or 6 months poststroke.
Conclusions—PREP algorithm predictions modify therapy content and increase rehabilitation efficiency after stroke without compromising clinical outcome.
There is not too much to say about this article that is not already included. As usual, it was impossible to recruit the targeted number of participants in a stroke recovery study and in the available timeline. If you’re a therapist or nurse who is working in stroke recovery and you find out about a study that you could help recruit patients into, please support that investigation as best as you can. So many stroke recovery studies struggle to recruit enough participants – even large, well-funded studies like AVERT, struggle. It takes a concerted effort to investigate stroke recovery outcomes and if you can contribute, I know your support will be appreciated and valued. OK, so I am getting well off-topic!!
Back to these findings: Using the scientifically proven, PREP algorithm to predict a patient’s potential to recover didn’t change the duration of upper limb therapy, but it did change the content of upper limb therapy and it shorted the patient’s length of stay. Also, therapists felt more confident about what they were doing and why. Predicting recovery potential is not about “writing off” some patients whilst favouring others; it is about designing recovery programs that meets the individual needs of each and every patient. Just as evidence-based practice is about working in the “sweet spot” where the evidence, the clinician and the patient meet; potential-based rehabilitation programming is about working in the “sweet spot” between the patient, the prediction and the potential meet.
As always, this is just my humble opinion – even if you’re not involved in upper limb recovery programs after stroke, this article will be of interest to you as it looks towards a future of individualized and integrated patient care.
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