Inpatient rehab improves post-stroke upper limb function

Stroke survivors who underwent inpatient rehabilitation experienced significant improvements in upper extremity (UE) impairment and in related UE-dependent activities of daily living (ADL), according to a recent study in Singapore.

“UE impairment is a common complication after a stroke, affecting more than 50 percent of stroke survivors. The ability to reliably predict UE recovery, especially for those with severe impairment, would therefore help stroke survivors and caregivers assess the level of caregiving needs required upon hospital discharge,” said the researchers.

The researchers conducted a retrospective cohort study of 259 stroke survivors (mean age 62.9 years, 61 percent male) admitted to Tan Tock Seng Hospital rehabilitation centre in Singapore over a 1-year period (January to December 2017).

UE impairment and functional status were assessed using the Fugl–Meyer Assessment-UE (FMA‑UE) and the Functional Independence Measure‑ADL (FIM‑ADL), respectively. Using the FMA-UE score, upper limb function was categorized into four levels: no to poor, limited, notable, and full arm-hand capacity. [Singapore Med J 2026;doi:10.4103/singaporemedj.SMJ-2025-046]

After inpatient rehabilitation, the mean FMA-UE score significantly improved from 29.1 at admission to 37.4 at discharge (p<0.001), as well as the mean FIM-ADL score, which significantly increased from 22.5 to 27.3 (p<0.001).

The researchers noted that the relatively low mean FMA-UE score of 29.1 suggests that most stroke survivors had significant UE weakness upon admission. Accordingly, the majority (52.1 percent) of participants were classified as having no to poor arm-hand capacity, followed by those with limited (12.7 percent), notable (6.6 percent), and full (28.6 percent) capacity.

At discharge, only 13.3 percent of stroke survivors with no to poor arm-hand capacity achieved good UE outcomes, defined as notable or full arm-hand capacity. By contrast, 72.7 percent of stroke survivors with limited arm-hand capacity achieved good UE outcomes.

Significant correlations were also observed between FMA-UE scores and MOCA*, NIHSS**, and TIS*** scores at admission. The researchers noted that stroke survivors with better cognition, less severe stroke, and better truncal balance had higher FMA-UE scores.

Although significant improvements in UE impairment and related UE-dependent ADL were observed after inpatient rehabilitation in this cohort of stroke survivors, the researchers reported that the outcomes were poor in those with no to poor arm‑hand capacity, whereas those with limited arm‑hand capacity demonstrated considerably better results.