Journal of Rehabilitation Medicine 51-4inkOmslag | Page 23

J Rehabil Med 2019; 51: 257–263 ORIGINAL REPORT EVALUATION OF A SHORT ASSESSMENT FOR UPPER EXTREMITY ACTIVITY CAPACITY EARLY AFTER STROKE Therese KRISTERSSON, RPT, MSc 1,2 , Hanna C. PERSSON, RPT, PhD 1,2 and Margit ALT MURPHY, RPT, PhD 1,2 From the 1 Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, and 2 Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden Objective: To explore the concurrent validity, re- sponsiveness, and floor- and ceiling-effects of the 2 items of Action Research Arm Test (ARAT-2) in com- parison 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 re- sponsive short assessment for upper extremity acti- vity capacity, and suitable for use in the acute stage after stroke. However, when the highest score has been reached, the assessment needs to be comple- mented with other instruments. Key words: stroke rehabilitation; motor function; upper ex- tremity; activity capacity; patient outcome assessment; vali- dation studies, behaviour rating scale. Accepted Jan 30, 2019; Epub ahead of print Feb 15, 2019 J Rehabil Med 2019; 51: 257–263 Correspondence address: Margit Alt Murphy, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Uni- versity of Gothenburg, Per Dubbsgatan 14, SE413 45 Gothenburg, Sweden. E-mail: [email protected] A pproximately 22,000 persons experience acute stroke each year in Sweden (1). Upper extremity impairment, reported in 48–77% of patients in the acute phase, is one of the most common sequelae after stroke (2, 3). Impaired function limits voluntary, well-coordinated effective movements (4) and can lead to activity limitations (5), reduced independence and participation in social and physical environment (6). Improvement in upper extremity occurs mainly during the first 4 weeks (7, 8). This recovery can be explained 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 mea- ningful improvements in arm function. This study in- vestigated 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 recommen- ded as an outcome measure early after stroke. How­ ever, when the highest score is reached in ARAT-2, other assessments may be needed to evaluate minor deficits or improvements in arm function. by resorption of cellular oedema of the non-infarcted penumbral areas around the infarcted area, and cortical as well as subcortical reorganization (8–10). Functional improvement can still be achieved even after the early sub-acute stage, although to a lesser degree (6, 11). The median stay in hospital according to the Swedish Stroke Register (12) was 8 days in 2016 (1). A short hospital stay requires an early assessment so that an app- ropriate plan can be made for discharge and rehabilita- tion in the short and long term (2). Initial motor function during the first 4 weeks after stroke is an important factor predicting upper extremity recovery (13, 14). Appropriate outcome measures should be used to discover meaningful improvements in motor function and activity. In addition to validity and reliability, a standardized clinical assessment needs to be sensitive to changes over time (15). Action Research Arm Test (ARAT) (16, 17) and Fugl-Meyer Assessment for upper extremity (FMA-UE) (18) are 2 recommended assessments to evaluate upper extremity activity ca- pacity and impairment, respectively (19). Both scales are considered time consuming and therefore rarely used in acute clinical settings. The ARAT also requires special equipment. Thus, there is a clinical need for a short assessment for the upper extremity in the acute stage after stroke. Clinical assessment in the acute stage should ide- ally be easy to administer, time effective, not require special equipment, be valid for severe to mild stroke This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2534