title: Can stroke survivors with severe upper arm disability achieve a clinically important change in arm function during inpatient rehabilitation? A multicentre, prospective, observational study.
abstract: BACKGROUND
  Severe arm disability is considered to indicate poor potential to recover arm function.
  
  
  OBJECTIVE
  Determine if stroke survivors with severe upper arm disability can achieve a clinically important change in arm function on discharge from inpatient rehabilitation.
  
  
  METHODS
  618 stroke survivors from 16 inpatient rehabilitation units were assessed on admission and discharge using the Motor Assessment Scale Item 6 Upper Arm Function (MAS6). Admission scores defined participants with severe (MAS6 ≤2) and mild/moderate (MAS6 >2) upper arm disability. A clinically important change was evaluated according to: 1) statistical significance; 2) minimal clinical importance difference (MCID); and 3) shift in disability status i.e., severe to mild/moderate. Achievers of a MCID and shift were compared to non-achievers.
  
  
  RESULTS
  Stroke survivors with severe upper arm disability (n = 226) demonstrated a significant improvement in arm function (p < 0.001) at discharge. A MCID was achieved by 68% (n = 155) and a shift from severe to mild/moderate upper arm disability on discharge by 45% (n = 102) of participants. Achievers had a significantly shorter interval from stroke onset to inpatient rehabilitation admission (p < 0.002).
  
  
  CONCLUSIONS
  Stroke survivors with severe upper arm disability can achieve a clinically important change during inpatient rehabilitation.
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Kathryn S
authors.initials: KS
authors.lastname: Hayward
authors.affiliation: Griffith Health Institute, Griffith University, Gold Coast, Australia; and Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Suzanne S
authors.initials: SS
authors.lastname: Kuys
authors.affiliation: Discipline of Physiotherapy, School of Public Health Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD, Australia Community Rehab Northern Queensland, Townsville Mackay Medicare Local, Townsville, QLD, Australia.
authors.forename: Ruth N
authors.initials: RN
authors.lastname: Barker
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Brauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D017741:Survivors
keywords: Stroke; functional recovery; inpatient rehabilitation; motor; severe