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Participant Perception of Recovery as Criterion to Establish Importance of Improvement for Constraint-Induced Movement Therapy Outcome Measures: Results From a Preliminary Study

SL Fritz, PT, PhD, is Clinical Assistant Professor, Physical Therapy Program, Department of Exercise Science, University of South Carolina, 1300 Wheat St, Blatt PE Bldg, Columbia, SC 29208 (USA).
SZ George, PT, PhD, is Assistant Professor, Department of Physical Therapy, College of Public Health and Health Professions, Brooks Center for Rehabilitation Studies, University of Florida, Gainesville, Fla.
SL Wolf, PT, PhD, FAPTA, is Professor, Center for Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Ga.
KE Light, PT, PhD, is Associate Professor, Department of Physical Therapy, College of Public Health and Health Professions, University of Florida.

sfritz{at}gwm.sc.edu

BACKGROUND AND PURPOSE: Changes in function following constraint-induced movement therapy (CIMT) are characterized primarily by improvements in performance; however, the importance of these outcome measures to the participant may be unclear. The primary purpose of this study was to determine whether either change scores or raw follow-up scores for the Motor Activity Log amount scale (MALa) and the Wolf Motor Function Test (WMFT) predicted participants' self-reports of recovery of upper-extremity function at 4 to 6 months after starting CIMT.

SUBJECTS AND METHODS: This study was a secondary analysis of a cohort of subjects (N=46) who participated in CIMT trials. Subjects completed measures at baseline and 4 to 6 months later. Hierarchical regression models determined whether change scores or raw follow-up scores of CIMT outcome measures were predictive of perceived recovery. Receiver operating characteristic (ROC) curves determined cutoff scores for measures that significantly contributed to participants' reports of perceived recovery.

RESULTS: The regression models indicated that raw follow-up MALa scores (ß=0.80, P=.024) and WMFT scores (ß=–0.37, P=.03) contributed to perceived recovery. Proposed cutoff scores for the MALa scores were less than 1.15 (negative likelihood ratio (LR)=0.17) for predicting less than 50% recovery and greater than 2.50 (positive LR=2.75) for predicting 50% or greater recovery. Proposed cutoff scores for follow-up WMFT scores were greater than 34 seconds (negative LR=0.24) for predicting less than 50% recovery and less than 11 seconds (positive LR=5.96) for predicting 50% or greater recovery.

DISCUSSION AND CONCLUSION: Raw follow-up scores for the MALa and WMFT were better predictors of self-report of recovery in comparison with change scores. These data also serve as a starting point for developing cutoff scores that accurately predict self-report of recovery.

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