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The EXCITE Trial: Predicting a Clinically Meaningful Motor Activity Log Outcome

Department of Stroke Rehabilitation, National Rehabilitation Center, Seoul, Korea, seanpark05{at}yahoo.co.kr, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia

Steven L. Wolf, PhD, PT, FAPTA, FAHA

Department of Rehabilitation Medicine, Center for Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia

Sarah Blanton, DPT

Department of Rehabilitation Medicine, Center for Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia

Carolee Winstein, PhD, PT, FAPTA

Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles

Deborah S. Nichols-Larsen, PhD

School of Allied Medical Professions, Ohio State University, Columbus

Background and Objective . This study determined which baseline clinical measurements best predicted a predefined clinically meaningful outcome on the Motor Activity Log (MAL) and developed a predictive multivariate model to determine outcome after 2 weeks of constraint-induced movement therapy (CIMT) and 12 months later using the database from participants in the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial. Methods. A clinically meaningful CIMT outcome was defined as achieving higher than 3 on the MAL Quality of Movement (QOM) scale. Predictive variables included baseline MAL, Wolf Motor Function Test (WMFT), the sensory and motor portion of the Fugl-Meyer Assessment (FMA), spasticity, visual perception, age, gender, type of stroke, concordance, and time after stroke. Significant predictors identified by univariate analysis were used to develop the multivariate model. Predictive equations were generated and odds ratios for predictors were calculated from the multivariate model. Results. Pretreatment motor function measured by MAL QOM, WMFT, and FMA were significantly associated with outcome immediately after CIMT. Pretreatment MAL QOM, WMFT, proprioception, and age were significantly associated with outcome after 12 months. Each unit of higher pretreatment MAL QOM score and each unit of faster pretreatment WMFT log mean time improved the probability of achieving a clinically meaningful outcome by 7 and 3 times at posttreatment, and 5 and 2 times after 12 months, respectively. Patients with impaired proprioception had a 20% probability of achieving a clinically meaningful outcome compared with those with intact proprioception. Conclusions. Baseline clinical measures of motor and sensory function can be used to predict a clinically meaningful outcome after CIMT.

Key Words: Stroke • Rehabilitation • Outcome • Prediction.

Neurorehabilitation and Neural Repair, Vol. 22, No. 5, 486-493 (2008)
DOI: 10.1177/1545968308316906


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