Evaluation of a shortened version of the Action Research Arm Test (ARAT) for upper extremity function after stroke: The Mini-ARAT

Abstract

Objectives

(i) to create a shortened version of the Action Research Arm Test scale, (ii) to investigate its psychometric properties compared to the original scale and (iii) to externally validate it within an independent cohort.

Design

Prospective longitudinal cohort study.

Settings

Two University Hospitals (France, Switzerland).

Participants

47 patients with poststroke motor deficits of the upper limb coming from two different sites were included and divided into two cohorts (n = 22 for the construction cohort; n = 25 for the validation cohort).

Main Measures

We used the first cohort to build the Mini-ARAT by shortening the Action Research Arm Test scale on the basis of ceiling/floor effects and collinearity of the subscales. We studied its reliability, validity, and responsiveness and performed an external validation with the second cohort.

Results

The Mini-ARAT consisted of 2 subscales from the original Action Research Arm Test scale (Grip and Pinch). Internal consistency (α = 87) and inter-rater reliability (0.99, 95% CI: 0.98–0.99, p < 0.01) were good and similar to those of the Action Research Arm Test scale. The Minimal Clinically Important Difference of the Mini-ARAT was 9 points. The predictive validity in the construction and validation cohorts showed good correlation between the Mini-ARAT at baseline and the Fugl Meyer at 3 months (rho, 95% CI: 0.77, 0.49–0.90, p < 0.01, and 0.58, 0.19–0.96, p < 0.01).

Conclusion

The Mini-ARAT is a time-effective tool able to capture the dynamics of motor deficits with high reliability and consistency, providing excellent information about residual motor functions, which is critically important for clinical and research purposes.

Keywords

Stroke rehabilitation motor function upper limb assessment

Get full access to this article

View all access options for this article.

References

Varghese

Oyere

Cowan

, et al. World health organization. Stroke 2016; 47: e210.

Lyle

. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res 1981; 4: 483–492.

Gladstone

Danells

Black

. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair 2002; 16: 232–240.

Amano

Umeji

Takebayashi

, et al. Clinimetric properties of the shortened Fugl-Meyer assessment for the assessment of arm motor function in hemiparetic patients after stroke. Top Stroke Rehabil 2020; 27: 290–295.

Persson

Alt Murphy

Danielsson

, et al. A cohort study investigating a simple, early assessment to predict upper extremity function after stroke – a part of the SALGOT study. BMC Neurol 2015; 15: 1–8.

Kristersson

Persson

Alt Murphy

. Evaluation of a short assessment for upper extremity activity capacity early after stroke. J Rehabil Med 2019; 51: 257–263.

Yozbatiran

Der-Yeghiaian

Cramer

. A standardized approach to performing the action research arm test. Neurorehabil Neural Repair 2008; 22: 78–90.

Hsueh

Hsu

Sheu

, et al. Psychometric comparisons of 2 versions of the Fugl-Meyer motor scale and 2 versions of the strok rehabilitation assessment of movement. Neurorehabil Neural Repair 2008; 22: 737–744.

Andresen

. Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil 2000; 81: 15–20.

10.

Terwee

Bot

SDM

de Boer

, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007; 60: 34–42.

11.

Lang

Edwards

Birkenmeier

, et al. Estimating minimal clinically important differences of upper-extremity measures early after stroke. Arch Phys Med Rehabil 2008; 89: 1693–1700.

12.

de Vet

HCW

Terwee

. The minimal detectable change should not replace the minimal important difference. J Clin Epidemiol 2010; 63: 804–805.

13.

Hsieh

Wang

, et al. Establishing the minimal clinically important difference of the barthel index in stroke patients. Neurorehabil Neural Repair 2007; 21: 233–238.

14.

Mouelhi

Jouve

Castelli

, et al. How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcomes 2020; 18: 1–18.

15.

Lauridsen

Hartvigsen

Manniche

, et al. Responsiveness and minimal clinically important difference for pain and disability instruments in low back pain patients. BMC Musculoskelet Disord 2006; 7: 1–16.

16.

Copay

Subach

Glassman

, et al. Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 2007; 7: 541–546.

17.

Hsueh

Hsieh

. Responsiveness of two upper extremity function instruments for stroke inpatients receiving rehabilitation. Clin Rehabil 2002; 16: 617–624.

18.

Nijland

van Wegen

Verbunt

, et al. A comparison of two validated tests for upper limb function after stroke: the wolf motor function test and the action research arm test. J Rehabil Med 2010; 42: 694–696.

19.

Lang

Wagner

Dromerick

, et al. Measurement of upper-extremity function early after stroke: properties of the action research arm test. Arch Phys Med Rehabil 2006; 87: 1605–1610.

20.

Chen

Lin

, et al. Rasch validation and predictive validity of the action research arm test in patients receiving stroke rehabilitation. Arch Phys Med Rehabil 2012; 93: 1039–1045.

21.

Boateng

Neilands

Frongillo

, et al. Best practices for developing and validating scales for health, social, and behavioral research: a primer. Front Public Health 2018; 6: 1–18.

22.

Kim

. The effects of hand strength on upper extremity function and activities of daily living in stroke patients, with a focus on right hemiplegia. J Phys Ther Sci 2016; 28: 2565–2567.

23.

Eschmann

Héroux

Cheetham

, et al. Thumb and finger movement is reduced after stroke: an observational study. PLoS ONE 2019; 14: 1–14.

24.

Bae

Kang

Seo

, et al. Relationship between grip and pinch strength and activities of daily living in stroke patients. Ann Rehabil Med 2015; 39: 752–762.

25.

Latash

Yue

, et al. The effects of stroke and age on finger interaction in multi-finger force production tasks. Clin Neurophysiol 2003; 114: 1646–1655.