Suica Z1, Rizza J1,2, Blum F1,3, Schuster-Amft C1,4,5
1Reha Rheinfelden, Research Department, Rheinfelden, Switzerland, 2University of Leipzig, Faculty of Sports Sciences, Leipzig, Germany, 3Albert Ludwig University of Freiburg, Department of Sports Science and Physical Education, Freiburg, Germany, 4Bern University of Applied Sciences, Institute for Rehabilitation and Performance Technology, Burgdorf, Switzerland, 5University of Basel, Department of Sport, Exercise and Health, Basel, Switzerland

Background: The Chedoke Arm and Hand Activity Inventory (CAHAI) is a validated upper-limb measure to assess functional recovery of the arm and hand after a stroke. A German version (CAHAI-G) with a cross-cultural adaptation and evaluation of the interrater reliability exist. However, responsiveness and intrarater reliability of the German version were not investigated so far.

Purpose: The aims of the present study were to evaluate responsiveness and intrarater reliability of the CAHAI-G by patients following stroke.

Methods: Inpatients following first stroke were included in this study. To test the instrument's responsiveness, CAHAI-G change score were compared to Action Research Arm Test (ARAT) score, which were administered on three different measurement sessions. A patient- and therapist-based Global Rating of Change and Global Rating of Concept were used for evaluation of changes between second and third measurement sessions. The instruments' ability to distinguish between improved and stable patients was analysed. To calculate intrarater reliability, patient's performance were video recorded and then independently assessed by three raters in three sessions with at least seven days apart.

Results: For responsiveness, data of 28 patients (mean age 62.8±13.7 years; 10 females; mean time since stroke onset: 40.6±78.5 days) were analysed. A high correlation between CAHAI-G and ARAT score were calculated (r=0.60, p=0.001). The CAHAI-G demonstrated large responsiveness with a standardized response mean (SRM) of 1.1 point, and Minimal Detectable Change (MDC90%) was 8.2 points. Area under the Receiver Operating Characteristics of the CAHAI-G responsiveness revealed a probability of 60% (95% CI =0.32-0.95) to correctly distinguish between improved and stable patients.
In total, 29 patient (mean age 63.2±14.1 years; 10 females; mean time since stroke onset: 40.21±78.6) were analysed for intrarater reliability. A high intrarater reliability for all three raters was established for CAHAI-G with an ICC=0.99 (95%CI=0.98-1.00).

Conclusion(s): A large responsiveness and high intrarater reliability of the CAHAI-G support clinical implementation of the translated version. However, the limited ability of CAHAI-G to correctly distinguish between patients with improved and unaltered upper extremity function should be considered.

Implications: CAHAI-G can be used as a valid and reliable assessment to evaluate a functional recovery of the arm and hand in patients after stroke. In clinical practice, a Minimal Detectable Change of 8.2 points should be taken into account in interpreting changes of functional recovery.

Keywords: Intrarater reliability, responsiveness, stroke

Funding acknowledgements: This study was not funded

Topic: Neurology: stroke; Disability & rehabilitation; Outcome measurement

Ethics approval required: Yes
Institution: Reha Rheinfelden
Ethics committee: North-Western and Central Switzerland
Ethics number: 2017-00161

All authors, affiliations and abstracts have been published as submitted.

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