The long-term outcome of arm function after stroke: results of a follow-up study

PURPOSE: To assess the long-term motor and functional recovery of arm function after stroke. DESIGN: Cohort study. SUBJECTS: Fifty-four patients with a first stroke, who underwent inpatient rehabilitation, were measured early after stroke, after 16 weeks and after 4 years. MEASURES: Fugl-Meyer Motor Assessment (FM, upper extremity), Action Research Arm Test (ARA), Barthel Index, Arm Function Questionnaire, shoulder pain and range of motion, sensory function, Ashworth Scale and a perceived problem score. RESULTS: Although most of the improvement occurred during the first 16 weeks after stroke, improvement in the FM score continued after 16 weeks in 10 patients. In 13 patients the recovery of arm function only started after 16 weeks. After 4 years a fair to good recovery of arm motor function (FM score > 20) was found in 31 patients. Twenty-seven patients had fair to good functional abilities of the hemiplegic arm (ARA > 25). Submaximal ARA scores for the unaffected arm were found in 11 patients. Barthel scores > 60 were found in 52 patients. Serious shoulder pain persisted in 11 patients. Intact sensory function was found in only 14 patients. It was associated with good motor recovery (FM score > 35 in 11 patients). Loss of arm function was perceived as a major problem by 36 patients. CONCLUSION: This is the first study to investigate the recovery of arm function after stroke over a period of 4 years. It is encouraging to note that even after 16 weeks improvement still occurred in some patients. However, considerable long-term loss of arm function, associated disability and perceived problems were found. There is an obvious need to develop effective treatment methods for hemiplegic arm function.