Prediction of Motor Recovery and Outcomes After Stroke

Abstract

Clinicians often have to make predictions on recovery and outcomes of patients after stroke. These predictions are necessary for physicians, therapists, and nurses to inform patients about their prognoses, set therapy goals, select interventions, and plan discharge destination. In this chapter, we provide an overview of prediction models of motor recovery and outcomes after stroke. Motor recovery and outcomes refer to arm motor function, arm activity, leg motor function, leg activity, and global disability. Readers will learn about integrating clinical experience and research evidence to guide predictions of motor recovery and outcomes after stroke. Readers will also learn how to determine if a prediction model is ready for use in clinical practice by considering four criteria: a) recruitment of representative cohort, b) standardized measurement of predictors, c) standardized measurement of outcome, and d) external validation of model. Prediction models that have fulfilled these four criteria are highlighted. At present, prediction models of global disability are potentially more ready for use in clinical practice than models of arm and leg function and activities. Notable prediction models of global disability include the ASTRAL score for ischemic strokes and the ESSEN ICH score for hemorrhagic strokes. To ensure that patients receive ongoing appropriate care, we encourage clinicians to reassess patients regularly. In terms of future research, we need more external validation and impact studies. In addition, patient-specific, time-dependent recovery models need to be developed so that clinicians can predict patients’ outcomes at multiple time points after stroke and adjust care accordingly.