Kristersson T1,2, Persson H1,2, Alt Murphy M1,2
1Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Clinical Neuroscience, Rehabilitation Medicine, Gothenburg, Sweden, 2Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
Background: Upper extremity impairments are common after stroke. The recommended standardized outcome measures are time consuming and/or require special equipment. There is a clinical need for a short screening test for upper extremity early after stroke. The ARAT-2 consists of two items of the Action Research Arm Test (ARAT) and has shown to predict well functional outcome early after stroke, but its validity in the acute and subacute stage after stroke has not been evaluated in clinical settings.
Purpose: To explore the floor- and ceiling effect of ARAT-2, its concurrent validity and responsiveness in comparison with the original ARAT and the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) during the first four weeks post stroke.
Methods: A non-selected cohort of 117 adults with first ever stroke and impaired upper extremity function were included three days post stroke. The activity capacity and motor function was assessed with ARAT and FMA-UE at three days, ten days and four weeks post-stroke. ARAT-2 results were calculated from the ARAT.
Results: ARAT-2, similarly to ARAT, showed a floor effect at all time-points. The ceiling effect was reached earlier using ARAT-2 than with ARAT and FMA-UE. The correlation between ARAT-2 and the other assessment scales was high (r=0.92-0.97) and ARAT-2 showed statistically significant changes between all time-points (effect size r=0.31-0.48). The effect sizes for the change in ARAT and FMA-UE varied from 0.44 to 0.53.
Conclusion(s): The ARAT-2 appears to be valid and responsive screening assessment for upper extremity activity capacity early after stroke. However, when the highest score has been reached, the assessment needs to be complemented with other instruments.
Implications: The ARAT-2 can be used as a short first screening test in clinical settings during the first weeks after stroke to evaluate upper extremity activity capacity and to guide the selection of complementary assessments and treatment planning.
Keywords: Stroke Rehabilitation, Upper Extremity, Activity Capacity
Funding acknowledgements: Supported by: Local Research and Development Board for Gothenburg and Southern Bohuslän, Swedish Foundation for Neurological Disabilities, Swedish Stroke Association
Purpose: To explore the floor- and ceiling effect of ARAT-2, its concurrent validity and responsiveness in comparison with the original ARAT and the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) during the first four weeks post stroke.
Methods: A non-selected cohort of 117 adults with first ever stroke and impaired upper extremity function were included three days post stroke. The activity capacity and motor function was assessed with ARAT and FMA-UE at three days, ten days and four weeks post-stroke. ARAT-2 results were calculated from the ARAT.
Results: ARAT-2, similarly to ARAT, showed a floor effect at all time-points. The ceiling effect was reached earlier using ARAT-2 than with ARAT and FMA-UE. The correlation between ARAT-2 and the other assessment scales was high (r=0.92-0.97) and ARAT-2 showed statistically significant changes between all time-points (effect size r=0.31-0.48). The effect sizes for the change in ARAT and FMA-UE varied from 0.44 to 0.53.
Conclusion(s): The ARAT-2 appears to be valid and responsive screening assessment for upper extremity activity capacity early after stroke. However, when the highest score has been reached, the assessment needs to be complemented with other instruments.
Implications: The ARAT-2 can be used as a short first screening test in clinical settings during the first weeks after stroke to evaluate upper extremity activity capacity and to guide the selection of complementary assessments and treatment planning.
Keywords: Stroke Rehabilitation, Upper Extremity, Activity Capacity
Funding acknowledgements: Supported by: Local Research and Development Board for Gothenburg and Southern Bohuslän, Swedish Foundation for Neurological Disabilities, Swedish Stroke Association
Topic: Neurology: stroke
Ethics approval required: Yes
Institution: The regional review board in Gothenburg
Ethics committee: Regional Ethics Committee, Gothenburg
Ethics number: 225-08
All authors, affiliations and abstracts have been published as submitted.
