Abstract
Objective
To investigate interrater and intrarater reliability, measurement error, and convergent
and discriminative validity of the Adult Assisting Hand Assessment Stroke (Ad-AHA
Stroke).
Design
Cross-sectional observational study.
Setting
A total of 7 stroke rehabilitation centers.
Participants
Stroke survivors (reliability sample: n=30; validity sample: N=118) were included
(median age 67y; interquartile range [IQR], 59-76); median time poststroke 81 days
(IQR 57-117).
Interventions
N/A.
Main Outcome Measures
Ad-AHA Stroke, Action Research Arm Test (ARAT), upper extremity Fugl-Meyer Assessment
(UE-FMA). The Ad-AHA Stroke is an observation-based instrument assessing the effectiveness
of the spontaneous use of the affected hand when performing bimanual activities in
adults poststroke. Reliability of Ad-AHA Stroke was examined using intraclass correlation
coefficients (ICCs), Bland–Altman plots, and weighted kappa statistics for reliability
on item level. SEM was calculated based on Ad-AHA units. Convergent validity was assessed
by calculating Spearman rank correlation coefficients between Ad-AHA Stroke and ARA
test and UE-FMA. Comparison of Ad-AHA Stroke scores between subgroups of patients
according to hand dominance, neglect, and age evaluated discriminative validity.
Results
Intrarater and interrater agreement showed an ICC of 0.99 (95% confidence interval,
0.99-0.99), an SEM of 2.15 and 1.64 out of 100, respectively, and weighted kappa for
item scores were all above 0.79. The relation between Ad-AHA and other clinical assessments was
strong (ρ=0.9). Patients with neglect had significantly lower Ad-AHA scores compared
to patients without neglect (P=.004).
Conclusions
The Ad-AHA Stroke captures actual bimanual performance. Therefore, it provides an
additional aspect of upper limb assessment with good to excellent reliability and
low SEM for patients with subacute stroke. High convergent validity with the ARA test
and UE-FMA and discriminative validity were supported.
Keywords
List of abbreviations:
Ad-AHA Stroke (Adult Assisting Hand Assessment Stroke), AHA (Assisting Hand Assessment), ARAT (Action Research Arm Test), CI (confidence interval), ICC (intraclass correlation coefficient), IQR (interquartile range), Kids-AHA (Kids Assisting Hand Assessment), UE-FMA (upper extremity Fugl-Meyer Assessment)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 25, 2018
Footnotes
Supported in part by grants from the Promobilia Foundation, Sweden (grant no. 15060), and from the Foundation Van Goethem-Brichant, Belgium.
Disclosures: Vincent Thijs reports personal fees from Medtronic, Pfizer, Boehringer/Ingelheim, Bayer, and BMS, outside the submitted work. Lena Krumlinde-Sundholm is involved in the company Handfast AB (Inc), which supplies training courses and test material for the Assisting Hand Assessment. She collaborated on the design of this specific study and reviewed the draft manuscript. Scoring of the Ad-AHA video observations, data analysis, and interpretation were independently performed. The other authors have nothing to disclose.
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© 2018 by the American Congress of Rehabilitation Medicine
