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Original report

Evaluation of a short assessment for upper extremity activity capacity early after stroke

Therese Kristersson, Hanna C. Persson, Margit Alt Murphy


DOI: 10.2340/16501977-2534

Abstract

Objective: To explore the concurrent validity, responsiveness, and floor- and ceiling-effects of the 2 items of Action Research Arm Test (ARAT-2) in comparison with the original ARAT and the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) during the first 4 weeks post-stroke.
Design: A prospective longitudinal cohort study.
Subjects: A non-selected cohort of 117 adults with first-ever stroke and impaired upper extremity function.
Methods: The activity capacity and motor function was assessed with ARAT and FMA-UE at 3 days, 10 days and 4 weeks post-stroke.
Results: 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. 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.
Conclusion: ARAT-2 appears to be valid and a responsive short assessment for upper extremity activity capacity, and suitable for use in the acute stage after stroke. However, when the highest score has been reached, the assessment needs to be complemented with other instruments.

Lay Abstract

After a stroke most people may have difficulty using their affected arm and hand in daily life. Appropriate outcome measures should be used to evaluate meaningful improvements in arm function. This study investigated how well a short version of a standardized and recommended clinical test on arm function (ARAT-2) can be used in acute clinical settings. The results showed that ARAT-2, which includes 2 tasks (pour water from glass to glass, and place hand on top of the head), was able to measure limitations in arm function. ARAT-2 was also able to capture improvements over the first 4 weeks after the stroke. The ARAT-2 can be recommended as an outcome measure early after stroke. However, when the highest score is reached in ARAT-2, other assessments may be needed to evaluate minor deficits or improvements in arm function.

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