Melissa Bailey, MD

Lin C, Martin K, Arevalo Y, Harvey R, Prabhakaran S. Association of Proportional Recovery After Stroke with Health-Related Quality of Life. Stroke. 2021;52:2968–2971.

When anticipating the degree of recovery after stroke, motor deficit improvement has been well predicted by the proportional recovery rule. Post-stroke, many patients will regain 70% of the motor function that was lost, though this number often does not apply to those with severe initial deficits. However, return to prior motor functioning is only part of the recovery process, and measures of quality of life after stroke are also important in understanding a patient’s return to functionality after stroke. In a study by Lin et al., the authors sought to investigate whether achieving the 70% proportional recovery threshold was associated with improved health-related quality of life scores.

Patients included in this study were those with ischemic stroke resulting in motor weakness, and 84 were prospectively enrolled between 2017 and 2018. Only patients with a baseline modified Rankin Scale score of 0 were included. Strength scores within one week of stroke and at three months post-stroke were assessed using the Motricity Index (which measures arm, leg, and trunk control), as well as the Fugl-Meyer Upper Extremity (FM-UE) measure. Patients considered to be “proportional recoverers” were those that had regained at least 70% of the difference between the patient’s initial score on these motor assessments and the maximal score possible. The Neuro-QOL was used to measure health-related quality of life. Binomial logistic regression models were used to examine the association between quality of life and motor recovery. 48.8% of patients met the threshold of proportional recovery in both the FM-UE and Motricity Index. Failure to meet 70% proportional recovery was not associated with worse quality of life measures in strength and cognition, but did show increased odds of HRQOL depression (adjusted odds ratio, 13.82 [95% CI, 1.39-137.3]). 

Prior studies have demonstrated that the change in motor score from the acute to the chronic phase can be proportionally predicted by the initial severity of the motor deficit. However, this study demonstrates that quality of life measures are not necessarily impaired when the proportional recovery threshold is not met, except in the case of depressed mood. This highlights that patients’ quality of life can be impacted by more than motor recovery alone. A limitation of this study is that it only examined three areas of quality of life, and future studies may look at other quality of life domains.