Recovery of the upper limb post ischaemic stroke and the predictive value of the Orpington Prognostic Score

Objective: To document upper limb recovery in stroke patients and investigate whether the Orpington Prognostic Score (OPS) performed within 48 hours of admission to hospital post ischaemic stroke was a predictor of upper limb function at six months and two years. Design: Inception cohort design. Setting: Teaching Hospital. Subjects: One hundred and fourteen patients hospitalized with acute ischaemic stroke were stratified into three groups based on their OPS within 48 hours of admission post stroke and underwent further assessments at two weeks, six months and two years after stroke onset. Main measures: Rivermead Arm Score (RAS), Nine Hole Peg Test (NHPT) and grip strength (GS). Results: Patients with a good OPS and intermediate OPS showed significant recovery in all outcome measures for up to six months post stroke (p < 0.05), while those with a poor OPS at 48 hours showed no significant improvement (p > 0.05). The OPS score at 48 hours was the most highly correlated variable with upper limb outcome at six months (r = -0.728) and at two years (r = -0.712) compared with other variables such as age, class of stroke, sensation, grip strength and RAS. Conclusion: Stroke patients demonstrate differential upper limb recovery patterns which need to be taken in consideration when designing studies that investigate efficacy of rehabilitation, and the OPS is highly correlated with upper limb recovery at six months and two years.