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