What the Proportional Recovery Rule Is (and Is Not): Methodological and Statistical Considerations
What the Proportional Recovery Rule Is (and Is Not): Methodological and Statistical Considerations
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DOI：
10.1177/1545968319872996
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发表时间：
2019-11-01
影响因子：
4.2
通讯作者：
Luft, Andreas R.
中科院分区：
文献类型：
--
作者：
Kundert, Robinson;Goldsmith, Jeff;Luft, Andreas R.
2008 年，有人提出，通过 Fugl-Meyer 评估 (FMA) 测量，中风后 3 至 6 个月内非严重上肢运动损伤的恢复程度约为初始损伤的 0.7 倍（“比例恢复”）。与非重度偏瘫患者相比，大约 30% 的初始重度偏瘫患者没有表现出这样的恢复（“未恢复者”）。因此，有人提出，比例恢复规则（PRR）是一种自发机制的表现，该机制存在于所有轻度至中度麻痹患者中，但仅存在于一些重度麻痹患者中。自 PRR 推出以来，它随后被应用于其他运动和非运动障碍。这种对 PRR 的更普遍的调查导致了其表述和应用的不一致，使得跨研究很难得出结论，并引发了一些有说服力的批评。在这里，我们对报告比例回收率的不同研究进行了详细比较，并在适当的情况下批评了统计方法。总而言之，我们得出的结论是，现有数据总体上与 PRR 作为上肢运动恢复的人群水平模型基本一致；最近关于其消亡的报道被夸大了，因为这些报道过度关注个体主题级别预测这一不太确定的问题。展望未来，我们建议需要谨慎的方法论和新的分析方法来确认（或反驳）运动和其他中风后损伤自发恢复的系统特征，这可以通过人群或受试者水平的数学规则来捕获。
In 2008, it was proposed that the magnitude of recovery from nonsevere upper limb motor impairment over the first 3 to 6 months after stroke, measured with the Fugl-Meyer Assessment (FMA), is approximately 0.7 times the initial impairment ("proportional recovery"). In contrast to patients with nonsevere hemiparesis, about 30% of patients with an initial severe paresis do not show such recovery ("nonrecoverers"). Hence it was suggested that the proportional recovery rule (PRR) was a manifestation of a spontaneous mechanism that is present in all patients with mild-to-moderate paresis but only in some with severe paresis. Since the introduction of the PRR, it has subsequently been applied to other motor and nonmotor impairments. This more general investigation of the PRR has led to inconsistencies in its formulation and application, making it difficult to draw conclusions across studies and precipitating some cogent criticism. Here, we conduct a detailed comparison of the different studies reporting proportional recovery and, where appropriate, critique statistical methodology. On balance, we conclude that existing data in aggregate are largely consistent with the PRR as a population-level model for upper limb motor recovery; recent reports of its demise are exaggerated, as these excessively focus on the less conclusive issue of individual subject-level predictions. Moving forward, we suggest that methodological caution and new analytical approaches will be needed to confirm (or refute) a systematic character to spontaneous recovery from motor and other poststroke impairments, which can be captured by a mathematical rule either at the population or at the subject level.