Upper-Extremity Motor Recovery After Stroke: What Clinicians Can Expect with Usual Care

Introduction to Upper-Extremity Recovery Benchmarks

Stroke affects over 13 million people worldwide annually, with nearly 50% experiencing persistent arm and hand paresis that impairs daily activities and quality of life. While advanced therapies—like constraint-induced movement therapy and robot-assisted training—show promise, usual care remains the backbone of rehabilitation. Yet clinicians lack consolidated data on expected functional gains under standard protocols. Kolmos et al. address this gap by pooling outcomes from randomized trials and observational cohorts to establish clear recovery benchmarks.

Study Objectives and Rationale

The review had two primary aims:

1. Quantify the rate and magnitude of upper-extremity improvement under usual care during the subacute period.
2. Identify key covariates—baseline severity, lesion load, and initial motor function—that modulate recovery trajectories.

Reliable estimates help therapists counsel patients realistically, adjust therapy dosage, and enable researchers to perform accurate sample size calculations for future interventional trials.

Methods Overview

Search Strategy and Selection Criteria

Following PRISMA guidelines, the authors searched PubMed, CINAHL, and PEDro through December 2024 for studies reporting FMA-UE or ARAT scores at ≥2 time points in usual-care cohorts or control arms of randomized trials. Inclusion criteria were:

• Adults (<6 months post-stroke) with upper-limb paresis
• Usual-care groups of ≥10 participants
• Reported baseline and follow-up FMA-UE or ARAT scores

Excluded were sham-controlled arms, case series, and studies with <10 subjects. In total, 35 randomized trials (n=2,774) and 19 observational cohorts were included.

Data Extraction and Analysis

Two independent reviewers extracted mean changes in FMA-UE and ARAT at 4, 12, and 24 weeks. Meta-regression identified the impact of baseline severity (mild/moderate vs severe), initial motor score, and corticospinal tract lesion volume (via MRI) on recovery magnitude.

Key Findings: Expected Gains Under Usual Care

At 4 weeks post-stroke:

• FMA-UE: +10 points (minimal clinically important difference ≥5.2) :contentReference[oaicite:4]{index=4}
• ARAT: +8 points (clinically important difference ≥5.7).

At 12 weeks: FMA-UE gains average +12 points.
At 24 weeks: FMA-UE gains reach +16 points on average.

Patients with mild-to-moderate deficits improved more quickly than those with severe paresis. Higher baseline FMA-UE scores and smaller corticospinal lesion loads correlated with faster, larger gains.

Clinical Implications for Therapists

These benchmarks serve several practical purposes:

• Goal-Setting: Use expected gains (e.g., +10 points on FMA-UE at 4 weeks) to formulate SMART goals and align patient expectations.
• Therapy Planning: Adjust session frequency and intensity based on initial severity. Patients predicted to have slower recovery may benefit from adjunctive therapies (e.g., mental practice, action observation).
• Progress Monitoring: Compare individual progress to benchmark curves. Slower-than-expected gains may trigger re-evaluation of therapy strategies or investigation of comorbidities.

Limitations and Considerations

The review highlights important caveats:

• Heterogeneity in Usual Care: Therapy content and dosage varied across studies and regions, limiting direct comparability.
• Excluded Populations: Findings apply only to subacute (<6 months) hemiparetic stroke. Chronic stroke and non-hemiparetic deficits were outside the scope.

Clinicians should interpret benchmarks within their local rehabilitation context and individualize plans accordingly.

Putting Benchmarks into Practice

To integrate these insights into your stroke rehab workflow:

1. Assess baseline FMA-UE and ARAT scores within 1–2 weeks post-stroke.
   • Learn scoring details on StrokEngine.
2. Set intermediate goals at 4 and 12 weeks using expected improvement ranges.
3. Re-evaluate at specified intervals, adjusting therapy intensity and modalities (e.g., adding mental practice or functional electrical stimulation).
4. Document progress using standardized outcomes for insurance and quality-assurance purposes.

Future Directions in Stroke Recovery Research

Building on these benchmarks, future work should:

• Standardize usual-care protocols to reduce inter-study variability.
• Investigate early predictors (biomarkers, kinematic measures) to personalize recovery forecasts.
• Compare usual-care trajectories against novel interventions (e.g., noninvasive brain stimulation) to quantify added benefits.
• Extend follow-up beyond 24 weeks to map long-term recovery patterns.

Conclusion and Call to Action

Kolmos et al.’s meta-analysis provides vital reference values for upper-extremity motor recovery under standard rehabilitation: expect +10 FMA-UE points at 4 weeks and up to +16 points at 24 weeks. Applying these benchmarks helps clinicians set informed goals, monitor progress, and optimize therapy plans. Researchers benefit by using these estimates for sample size calculations and cross-study comparisons.

Ready to elevate your stroke rehabilitation practice? Explore our CEU course on upper-limb assessment and intervention strategies for hands-on training and deeper insights. Together, we can drive better patient outcomes.

References:

• Kolmos M, Munoz-Novoa M, Sunnerhagen K, Alt Murphy M, Kruuse C. Upper-extremity motor recovery after stroke: A systematic review and meta-analysis of usual care in trials and observational studies. J Neurol Sci. 2025;468:123341. doi:10.1016/j.jns.2024.123341
• Page SJ, Fulk GD, Boyne P. Clinically important differences for the Fugl-Meyer Assessment in stroke: Validation of minimal detectable change and clinically important difference. Phys Ther. 2012;92(3):618–625. doi:10.2522/ptj.20110271
• Lang CE, Bland MD, Bailey RR, Schaefer SY, Birkenmeier RL. Assessment of upper extremity impairment, function, and activity after stroke: Foundations for clinical decision making. J Hand Ther. 2013;26(2):104–115. doi:10.1016/j.jht.2013.01.008
• Lyle RC. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res. 1981;4(4):483–492. doi:10.1097/00004356-198112000-00005
• Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLOS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097