600 Section - Simplified assessment of upper limb dysfunction after stroke: decision tree analysis based on the International Classification of Functioning,Disability and Health

The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework for evaluating stroke patients across four key domains. However, due to the large number of ICF items and the complexity of its classification system, its practical application is often time-consuming, and requires substantial training for evaluators.

Design:

A cross-sectional study conducted in the rehabilitation departments of five hospitals. This study included stroke patients (ischemic or hemorrhagic; first-ever or recurrent), who were stratified into acute (1–7 days, 1.94%), subacute (8–180 days, 53.02%), and chronic ( >180 days, 41.38%) phases. All patients had CT/MRI-confirmed diagnoses, stable vital signs, and upper limb dysfunction. All participants completed the 56 items of the comprehensive ICF Core Set for stroke, and a decision tree model of ICF items significantly associated with the Fugl-Meyer Upper Extremity Scale (FM-UE) was constructed using the R package rpart.

Results:

A total of 464 participants after stroke were recruited. Ten ICF items that were strongly correlated with the FM-UE and P< 0.05, and the items were “d4400”, “d4401”, “d4402”, “d4403”, “d4450”, “d4451”, “d4452”, “d4453”, “d4454”, “d4455”. Finally, the decision tree model included: “d4401: grasping”, “d4553: turning or twisting the hands or arms” and “d4551: pushing”. The statistical significant accuracy of the model confusion matrix in validation was 0.7381 (P = 5.008e-13), and the AUC was 0.8406.

Conclusion:

This study identified ICF items highly correlated with the FMA-UE and developed a statistically significant decision tree model for assessing upper limb dysfunction after stroke. CLINICAL REHABILITATION IMPACT: The decision tree model based on key ICF items substantially reduces evaluation time, simplifies upper limb dysfunction assessment, enhances ICF application, and provides a simpler and more efficient assessment tool that represents a valuable addition to clinical tools for stroke rehabilitation.