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@ARTICLE{Bowman:901852,
      author       = {Bowman, Howard and Bonkhoff, Anna and Hope, Tom and
                      Grefkes, Christian and Price, Cathy},
      title        = {{I}nflated {E}stimates of {P}roportional {R}ecovery {F}rom
                      {S}troke},
      journal      = {Stroke},
      volume       = {52},
      number       = {5},
      issn         = {1524-4628},
      address      = {Philadelphia, Pa.},
      publisher    = {Lippincott Williams $\&$ Wilkins},
      reportid     = {FZJ-2021-03867},
      pages        = {1915 - 1920},
      year         = {2021},
      abstract     = {The proportional recovery rule states that most survivors
                      recover a fixed proportion $(≈70\%)$ of lost function
                      after stroke. A strong (negative) correlation between the
                      initial score and subsequent change (outcome minus initial;
                      ie, recovery) is interpreted as empirical support for the
                      proportional recovery rule. However, this rule has recently
                      been critiqued, with a central observation being that the
                      correlation of initial scores with change over time is
                      confounded in the situations in which it is typically
                      assessed. This critique has prompted reassessments of
                      patients’ behavioral trajectory following stroke in 2
                      prominent papers. The first of these, by van der Vliet et al
                      presented an impressive modeling of upper limb deficits
                      following stroke, which avoided the confounded correlation
                      of initial scores with change. The second by Kundert et al
                      reassessed the value of the proportional recovery rule, as
                      classically formulated as the correlation between initial
                      scores and change. They argued that while effective
                      prediction of recovery trajectories of individual patients
                      is not supported by the available evidence, group-level
                      inferences about the existence of proportional recovery are
                      reliable. In this article, we respond to the van der Vliet
                      and Kundert papers by distilling the essence of the argument
                      for why the classic assessment of proportional recovery is
                      confounded. In this respect, we reemphasize the role of
                      mathematical coupling and compression to ceiling in the
                      confounded nature of the correlation of initial scores with
                      change. We further argue that this confound will be present
                      for both individual-level and group-level inference. We then
                      focus on the difficulties that can arise from ceiling
                      effects, even when initial scores are not being correlated
                      with change/recovery. We conclude by emphasizing the need
                      for new techniques to analyze recovery after stroke that are
                      not confounded in the ways highlighted here.},
      cin          = {INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406},
      pnm          = {5252 - Brain Dysfunction and Plasticity (POF4-525)},
      pid          = {G:(DE-HGF)POF4-5252},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:33827246},
      UT           = {WOS:000644656300060},
      doi          = {10.1161/STROKEAHA.120.033031},
      url          = {https://juser.fz-juelich.de/record/901852},
}