Factors Explaining Limited Daily Hand-use in Individuals with Fair-Good Motor Ability Post-Stroke

BackgroundDespite fair-to-good motor ability of their affected upper extremity, individuals post-stroke often exhibit limited daily hand-use, possibly due to factors beyond the motor impairment.ObjectiveTo identify the factors that best explain the variance in daily hand-use, beyond the motor impairment.MethodsA cross-sectional study included individuals post-stroke with fair-to-good upper extremity motor ability (Fugl-Meyer Assessment>30/66). Hand-use was assessed using the Rating of Everyday Arm-Use in the Community and Home (REACH), which is a self-report questionnaire. We assessed the following factors (tools); proprioception (Thumb Localization Test), executive functions (Color Trails Test; upper extremity dual-task capacity), self-efficacy (Confidence in Arm and Hand Movement scale), and depressive symptoms (Geriatric Depression Scale). Ordinal logistic regression evaluated the contribution of these factors to daily hand-use.ResultsFifty-nine individuals post-stroke (41.7% women, aged 25-88). Despite high motor ability [median (IQR), FMA: 57 (51-63)], daily hand-use was limited, most participants scoring REACH levels 2-3 out of 5. Dual-task capacity and upper-extremity self-efficacy were significant predictors, explaining 45.9% of the variance in hand-use. Each unit increase in dual-task capacity and self-efficacy raised REACH levels by 5.8% and 4.2%, respectively. Proprioceptive deficits and depressive symptoms were not significant predictors.ConclusionsLimited hand-use was explained by reduced dual-task capacity and lower self-efficacy among individuals with fair-good upper-extremity motor ability post-stroke. These factors may represent promising targets for future rehabilitation interventions and should be considered during clinical assessment.