Factors associated with clinically meaningful improvement in upper limb motor function_West China Medical Journal

Authors：

LIU Zhixin , ZHANG Shuxian , CHENG Qilin ,  HU Xiquan

Department of Rehabilitation Medicine, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P. R. China;

Corresponding?author：

HU Xiquan, Email: huxiquan@mail.sysu.edu.cn

Keywords：

Upper limb motor function; minimal clinically important difference; acquired brain injury; rehabilitation; influencing factors

DOI：

10.7507/1002-0179.202604281

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Objective To investigate factors associated with achieving minimal clinically important difference (MCID) in upper limb motor function after rehabilitation in patients with acquired brain injury (ABI). Methods Patients receiving rehabilitation therapy in the Third Affiliated Hospital of Sun Yat-sen University Hospital between April 2015 and October 2022 were retrospective selected. Upper limb motor function was assessed using the Fugl-Meyer Assessment- Upper Extremity (FMA-UE) at baseline and discharge. An increase of ≥5 points in the FMA-UE score was defined as achieving MCID. Logistic regression analyses were used to identify factors associated with achieving the MCID. Stratified analyses were conducted based on baseline FMA-UE scores (≤21 vs. >21). Results A total of 236 patients were included. Among them, there were 156 males and 80 females; 138 cases met the MCID, and 98 cases did not; 115 cases had FMA-UE scores ≤21, and 121 cases had FMA-UE scores >21. FMA-UE scores significantly improved after rehabilitation therapy compared with admission scores [21 (12, 36) vs. 29 (18, 47) scores, P<0.001]. The results of the multi-factor logistic analysis showed that in the severe impairment group, length of stay was associated with achieving MCID [odds ratio=1.028, 95% confidence interval (1.004, 1.052), P=0.019]. In the mild-to-moderate impairment group, female sex was negatively associated with achieving MCID [odds ratio=0.306, 95% confidence interval (0.107, 0.872), P=0.027]. Conclusions Different lengths of stay and genders may affect the achievement of MCID in ABI patients. Further prospective studies are needed to validate these findings.

Citation： LIU Zhixin, ZHANG Shuxian, CHENG Qilin, HU Xiquan. Factors associated with clinically meaningful improvement in upper limb motor function. West China Medical Journal, 2026, 41(6): 901-906. doi: 10.7507/1002-0179.202604281 Copy

1.	Goldman L, Siddiqui EM, Khan A, et al. Understanding acquired brain injury: a review. Biomedicines, 2022, 10(9): 2167.
2.	Akbarfahimi N, Mazidi MH, et al. The relationship between upper limb function and participation and independence in daily activities of life in people with stroke. J Rehabil, 2021, 22(1): 86-101.
3.	Pan H, Ng SSM, Liu TW, et al. Self-perceived upper extremity motor function predicts health-related quality of life in chronic stroke Survivors. Disabil Rehabil, 2025, 47(1): 186-193.
4.	Verberne DPJ, Post MWM, K?hler S, et al. Course of social participation in the first 2 years after stroke and its associations with demographic and stroke-related factors. Neurorehabil Neural Repair, 2018, 32(9): 821-833.
5.	Salvalaggio S, Cacciante L, Maistrello L, et al. Clinical predictors for upper limb recovery after stroke rehabilitation: retrospective cohort study. Healthcare (Basel), 2023, 11(3): 335.
6.	Coupar F, Pollock A, Rowe P, et al. Predictors of upper limb recovery after stroke: a systematic review and meta-Analysis. Clin Rehabil, 2011, 26(4): 291-313.
7.	Abdullahi A, Sabo B, Badaru UM, et al. Factors influencing recovery of upper limb motor function during constraint-induced movement therapy for people with stroke. Transl Neurosci, 2022, 13(1): 453-459.
8.	Snickars J, Persson HC, Sunnerhagen KS. Early clinical predictors of motor function in the upper extremity one month post-stroke. J Rehabil Med, 2017, 49(3): 216-222.
9.	Aprile I, Guardati G, Cipollini V, et al. Influence of cognitive impairment on the recovery of subjects with subacute stroke undergoing upper limb robotic rehabilitation. Brain Sci, 2021, 11(5): 587.
10.	Mullick AA, Subramanian SK, Levin MF. Emerging evidence of the association between cognitive deficits and arm motor recovery after stroke: a meta-analysis. Restor Neurol Neurosci, 2015, 33(3): 389-403.
11.	Wu J, Zhang J, Bai Z, et al. Predictive factors of upper limb motor recovery for stroke survivors admitted to a rehabilitation program. Eur J Phys Rehabil Med, 2021, 56(6): 706-712.
12.	Page SJ, Fulk GD, Boyne P. Clinically important differences for the upper-extremity fugl-meyer scale in people with minimal to moderate impairment due to chronic stroke. Phys Ther, 2012, 92(6): 791-798.
13.	Fugl-Meyer A, J??sk? L, Leyman I, et al. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med, 1975, 7(1): 13-31.
14.	陳瑞全, 吳建賢, 沈顯山. 中文版 Fugl-Meyer 運動功能評定量表的最小臨床意義變化值的研究. 安徽醫科大學學報, 2015, 50(4): 519-522.
15.	Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol, 1989, 42(8): 703-709.
16.	Folstein MF, Folstein SE, McHugh PR.“Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975, 12(3): 189-198.
17.	Woodbury ML, Velozo CA, Richards LG, et al. Rasch analysis staging methodology to classify upper extremity movement impairment after stroke. Arch Phys Med Rehabil, 2013, 94(8): 1527-1533.
18.	Doumen S, Sorba L, Feys P, et al. Efficacy and dose of rehabilitation approaches for severe upper limb impairments and disability during early acute and subacute stroke: a systematic review. Phys Ther., 2023, 103(4): pzad002.
19.	Lee CY, Howe TH. Effectiveness of activity-based task-oriented training on upper extremity recovery for adults with stroke: a systematic review. Am J Occup Ther, 2024, 78(2): 7802180070.
20.	Wolf S, Holm SE, Ingwersen T, et al. Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation. Ann Med, 2022, 54(1): 1265-1276.
21.	Finney CA, Shvetcov A, Westbrook RF, et al. The role of hippocampal estradiol in synaptic plasticity and memory: a systematic review. Front Neuroendocrinol, 2020, 56: 100818.
22.	Pan MX, Li J, Ma C, et al. Sex-dependent effects of GPER activation on neuroinflammation in a rat model of traumatic brain injury. Brain Behav Immun, 2020, 88: 421-431.
23.	Mehrabi S, Cameron L, Bowman A, et al. A systematic review of female participation in randomized controlled trials of post-stroke upper extremity rehabilitation in low- to middle-income countries and high-income countries and regions. Cerebrovasc Dis, 2025, 54(2): 260-269.
24.	Mehrabi S, Harnett A, Saikaley M, et al. Female enrollment in rehabilitation trials: a systematic review of reporting sex and female participation in randomized controlled trials of poststroke upper extremity rehabilitation over 50 years. Arch Phys Med Rehabil, 2024, 105(7): 1399-1406.
25.	Bushnell CD, Kapral MK. Stroke rehabilitation and recovery in women. Stroke, 2025, 56(5): 1295-1297.
26.	Xu S, Yan Z, Pan Y, et al. Associations between upper extremity motor function and aphasia after stroke: a multicenter cross-sectional study. Behav Neurol, 2021: 9417173.
27.	Veerbeek JM, Langbroek-Amersfoort AC, van Wegen EE, et al. Effects of robot-assisted therapy for the upper limb after stroke. Neurorehabil Neural Repair, 2016, 31(2): 107-121.
28.	Boardsworth K, Rashid U, Olsen S, et al. Upper limb robotic rehabilitation following stroke: a systematic review and meta-analysis investigating efficacy and the influence of device features and program parameters. J Neuroeng Rehabil, 2025, 22(1): 164.
29.	Cordo P, Wolf S, Rymer WZ, et al. Assisted movement with proprioceptive stimulation augments recovery from moderate-to-severe upper limb impairment during subacute stroke period: a randomized clinical trial. Neurorehabil Neural Repair, 2022, 36(3): 239-250.
30.	Park JM, Park HJ, Yoon SY, et al. Effects of robot-assisted therapy for upper limb rehabilitation after stroke: an umbrella review of systematic reviews. Stroke, 2025, 56(5): 1243-1252.
31.	Cecchi F, Germanotta M, Macchi C, et al. Age is negatively associated with upper limb recovery after conventional but not robotic rehabilitation in patients with stroke: a secondary analysis of a randomized-controlled trial. J Neurol, 2020, 268(2): 474-483.
32.	Lundquist CB, Nielsen JF, Brunner IC. Prediction of upper limb use three months after stroke: a prospective longitudinal study. J Stroke Cerebrovasc Dis, 2021, 30(11): 106025.
33.	Vanbellingen T, Van de Winckel A, Pastore-Wapp M, et al. Poor upper limb performance despite the absence of notable upper limb motor impairment in adults with acute stroke – the influence of cognitive deficits. Neuropsychol Rehabil, 2025, 36(4): 825-835.

1. Goldman L, Siddiqui EM, Khan A, et al. Understanding acquired brain injury: a review. Biomedicines, 2022, 10(9): 2167.
2. Akbarfahimi N, Mazidi MH, et al. The relationship between upper limb function and participation and independence in daily activities of life in people with stroke. J Rehabil, 2021, 22(1): 86-101.
3. Pan H, Ng SSM, Liu TW, et al. Self-perceived upper extremity motor function predicts health-related quality of life in chronic stroke Survivors. Disabil Rehabil, 2025, 47(1): 186-193.
4. Verberne DPJ, Post MWM, K?hler S, et al. Course of social participation in the first 2 years after stroke and its associations with demographic and stroke-related factors. Neurorehabil Neural Repair, 2018, 32(9): 821-833.
5. Salvalaggio S, Cacciante L, Maistrello L, et al. Clinical predictors for upper limb recovery after stroke rehabilitation: retrospective cohort study. Healthcare (Basel), 2023, 11(3): 335.
6. Coupar F, Pollock A, Rowe P, et al. Predictors of upper limb recovery after stroke: a systematic review and meta-Analysis. Clin Rehabil, 2011, 26(4): 291-313.
7. Abdullahi A, Sabo B, Badaru UM, et al. Factors influencing recovery of upper limb motor function during constraint-induced movement therapy for people with stroke. Transl Neurosci, 2022, 13(1): 453-459.
8. Snickars J, Persson HC, Sunnerhagen KS. Early clinical predictors of motor function in the upper extremity one month post-stroke. J Rehabil Med, 2017, 49(3): 216-222.
9. Aprile I, Guardati G, Cipollini V, et al. Influence of cognitive impairment on the recovery of subjects with subacute stroke undergoing upper limb robotic rehabilitation. Brain Sci, 2021, 11(5): 587.
10. Mullick AA, Subramanian SK, Levin MF. Emerging evidence of the association between cognitive deficits and arm motor recovery after stroke: a meta-analysis. Restor Neurol Neurosci, 2015, 33(3): 389-403.
11. Wu J, Zhang J, Bai Z, et al. Predictive factors of upper limb motor recovery for stroke survivors admitted to a rehabilitation program. Eur J Phys Rehabil Med, 2021, 56(6): 706-712.
12. Page SJ, Fulk GD, Boyne P. Clinically important differences for the upper-extremity fugl-meyer scale in people with minimal to moderate impairment due to chronic stroke. Phys Ther, 2012, 92(6): 791-798.
13. Fugl-Meyer A, J??sk? L, Leyman I, et al. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med, 1975, 7(1): 13-31.
14. 陳瑞全, 吳建賢, 沈顯山. 中文版 Fugl-Meyer 運動功能評定量表的最小臨床意義變化值的研究. 安徽醫科大學學報, 2015, 50(4): 519-522.
15. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol, 1989, 42(8): 703-709.
16. Folstein MF, Folstein SE, McHugh PR.“Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975, 12(3): 189-198.
17. Woodbury ML, Velozo CA, Richards LG, et al. Rasch analysis staging methodology to classify upper extremity movement impairment after stroke. Arch Phys Med Rehabil, 2013, 94(8): 1527-1533.
18. Doumen S, Sorba L, Feys P, et al. Efficacy and dose of rehabilitation approaches for severe upper limb impairments and disability during early acute and subacute stroke: a systematic review. Phys Ther., 2023, 103(4): pzad002.
19. Lee CY, Howe TH. Effectiveness of activity-based task-oriented training on upper extremity recovery for adults with stroke: a systematic review. Am J Occup Ther, 2024, 78(2): 7802180070.
20. Wolf S, Holm SE, Ingwersen T, et al. Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation. Ann Med, 2022, 54(1): 1265-1276.
21. Finney CA, Shvetcov A, Westbrook RF, et al. The role of hippocampal estradiol in synaptic plasticity and memory: a systematic review. Front Neuroendocrinol, 2020, 56: 100818.
22. Pan MX, Li J, Ma C, et al. Sex-dependent effects of GPER activation on neuroinflammation in a rat model of traumatic brain injury. Brain Behav Immun, 2020, 88: 421-431.
23. Mehrabi S, Cameron L, Bowman A, et al. A systematic review of female participation in randomized controlled trials of post-stroke upper extremity rehabilitation in low- to middle-income countries and high-income countries and regions. Cerebrovasc Dis, 2025, 54(2): 260-269.
24. Mehrabi S, Harnett A, Saikaley M, et al. Female enrollment in rehabilitation trials: a systematic review of reporting sex and female participation in randomized controlled trials of poststroke upper extremity rehabilitation over 50 years. Arch Phys Med Rehabil, 2024, 105(7): 1399-1406.
25. Bushnell CD, Kapral MK. Stroke rehabilitation and recovery in women. Stroke, 2025, 56(5): 1295-1297.
26. Xu S, Yan Z, Pan Y, et al. Associations between upper extremity motor function and aphasia after stroke: a multicenter cross-sectional study. Behav Neurol, 2021: 9417173.
27. Veerbeek JM, Langbroek-Amersfoort AC, van Wegen EE, et al. Effects of robot-assisted therapy for the upper limb after stroke. Neurorehabil Neural Repair, 2016, 31(2): 107-121.
28. Boardsworth K, Rashid U, Olsen S, et al. Upper limb robotic rehabilitation following stroke: a systematic review and meta-analysis investigating efficacy and the influence of device features and program parameters. J Neuroeng Rehabil, 2025, 22(1): 164.
29. Cordo P, Wolf S, Rymer WZ, et al. Assisted movement with proprioceptive stimulation augments recovery from moderate-to-severe upper limb impairment during subacute stroke period: a randomized clinical trial. Neurorehabil Neural Repair, 2022, 36(3): 239-250.
30. Park JM, Park HJ, Yoon SY, et al. Effects of robot-assisted therapy for upper limb rehabilitation after stroke: an umbrella review of systematic reviews. Stroke, 2025, 56(5): 1243-1252.
31. Cecchi F, Germanotta M, Macchi C, et al. Age is negatively associated with upper limb recovery after conventional but not robotic rehabilitation in patients with stroke: a secondary analysis of a randomized-controlled trial. J Neurol, 2020, 268(2): 474-483.
32. Lundquist CB, Nielsen JF, Brunner IC. Prediction of upper limb use three months after stroke: a prospective longitudinal study. J Stroke Cerebrovasc Dis, 2021, 30(11): 106025.
33. Vanbellingen T, Van de Winckel A, Pastore-Wapp M, et al. Poor upper limb performance despite the absence of notable upper limb motor impairment in adults with acute stroke – the influence of cognitive deficits. Neuropsychol Rehabil, 2025, 36(4): 825-835.

West China Medical Journal

Factors associated with clinically meaningful improvement in upper limb motor function

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