Predictors of upper limb recovery after stroke: a systematic review and meta-analysis.
OBJECTIVE
To systematically review and summarize the current available literature on prognostic variables relating to upper limb recovery following stroke. To identify which, if any variables predict upper limb recovery following stroke.


METHODS
We completed searches in MEDLINE, EMBASE, AMED, CINAHL and Cochrane CENTRAL databases. Searches were completed in November 2010.


METHODS
Studies were included if predictor variables were measured at baseline and linked to an outcome of upper limb recovery at a future time point. Exclusion criteria included predictor variables relating to response to treatment and outcome measurements of very specific upper limb impairments such as spasticity or pain. Two independent reviewers completed data extraction and assessed study quality.


RESULTS
Fifty-eight studies met the inclusion criteria. Predictor variables which have been considered within these studies include; age, sex, lesion site, initial motor impairment, motor-evoked potentials and somatosensory-evoked potentials. Initial measures of upper limb impairment and function were found to be the most significant predictors of upper limb recovery; odds ratio 14.84 (95% confidence intervals (CI) 9.08-24.25) and 38.62 (95% CI 8.40-177.53), respectively.


CONCLUSIONS
Interpretation of these results is complicated by methodological factors including variations in study populations, upper limb motor outcome scales, timing of baseline and outcome assessments and predictors selected. The most important predictive factors for upper limb recovery following stroke appears to the initial severity of motor impairment or function.
Glasgow University, Academic Section of Geriatric Medicine, Glasgow, UK. fmacvicar@yahoo.com
Fiona
F
Coupar
Alex
A
Pollock
Phil
P
Rowe
Christopher
C
Weir
Peter
P
Langhorne
D000367:Age Factors; D016206:Databases, Bibliographic; D005544:Forecasting / Q000379:methods; D006801:Humans; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D013997:Time Factors; D034941:Upper Extremity / Q000503:physiopathology*