Predictors of upper limb recovery following stroke: a systematic review

Background: Upper limb hemiparesis is a common, persisting and disabling sequela of stroke. However, evidence for the effectiveness of interventions targeted at the upper limb remains inconclusive. Identification of reliable predictors of upper limb recovery would allow interventions to be better targeted at appropriate patients and thus potentially optimise upper limb rehabilitation. We carried out a systematic review of predictors of upper limb recovery. Methods: We completed searches in Medline, Embase, Amed, Cinahl and Cochrane CENTRAL databases. Articles were included if predictor variables were measured at baseline and related to an outcome of upper limb recovery at a future time point. Exclusion criteria included predictor variables relating to a particular treatment and outcome measurements of very specific upper limb impairments such as spasticity or pain. Results: To date two independent reviewers have identified 54 studies (over 6000 participants) that meet 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. Preliminary results indicate that the severity of the initial upper limb impairment is the most consistently reported and significant predictor of upper limb recovery. Discussion: 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 factor for upper limb recovery following stroke appears to be the initial severity of motor impairment. This paper was presented at the XVII European Stroke Conference in 2009.