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Inter-individual Variability in the Capacity for Motor Recovery After Ischemic Stroke
- Source :
- Neurorehabilitation and Neural Repair. 22:64-71
- Publication Year :
- 2007
- Publisher :
- SAGE Publications, 2007.
-
Abstract
- Background. Motor recovery after stroke is predicted only moderately by clinical variables, implying that there is still a substantial amount of unexplained, biologically meaningful variability in recovery. Regression diagnostics can indicate whether this is associated simply with Gaussian error or instead with multiple subpopulations that vary in their relationships to the clinical variables. Objective. To perform regression diagnostics on a linear model for recovery versus clinical predictors. Methods. Forty-one patients with ischemic stroke were studied. Impairment was assessed using the upper extremity Fugl-Meyer Motor Score. Motor recovery was defined as the change in the upper extremity Fugl-Meyer Motor Score from 24 to 72 hours after stroke to 3 or 6 months later. The clinical predictors in the model were age, gender, infarct location (subcortical vs cortical), diffusion weighted imaging infarct volume, time to reassessment, and acute upper extremity Fugl-Meyer Motor Score. Regression diagnostics included a Kolmogorov-Smirnov test for Gaussian errors and a test for outliers using Studentized deleted residuals. Results. In the random sample, clinical variables explained only 47% of the variance in recovery. Among the patients with the most severe initial impairment, there was a set of regression outliers who recovered very poorly. With the outliers removed, explained variance in recovery increased to 89%, and recovery was well approximated by a proportional relationship with initial impairment (recovery ≅ 0.70 × initial impairment). Conclusions. Clinical variables only moderately predict motor recovery. Regression diagnostics demonstrated the existence of a subpopulation of outliers with severe initial impairment who show little recovery. When these outliers were removed, clinical variables were good predictors of recovery among the remaining patients, showing a tight proportional relationship to initial impairment.
- Subjects :
- Male
medicine.medical_specialty
Brain Ischemia
Disability Evaluation
Grubbs' test for outliers
Age Distribution
Physical medicine and rehabilitation
Predictive Value of Tests
medicine
Humans
Stroke
Aged
Observer Variation
Models, Statistical
Movement Disorders
Linear model
Reproducibility of Results
Recovery of Function
General Medicine
Middle Aged
medicine.disease
Explained variation
Regression
Paresis
Hemiparesis
Predictive value of tests
Female
medicine.symptom
Psychology
Regression diagnostic
Subjects
Details
- ISSN :
- 15526844 and 15459683
- Volume :
- 22
- Database :
- OpenAIRE
- Journal :
- Neurorehabilitation and Neural Repair
- Accession number :
- edsair.doi.dedup.....fad0c6f4dcd90bb48f52a63c7de07193
- Full Text :
- https://doi.org/10.1177/1545968307305302