Abstract
Objective – The present study aimed to create a shorter version of the Action Research Arm
Test (ARAT) without compromising its measurement properties.
Design – Secondary analysis of stroke recovery cohorts that used the ARAT to measure upper-limb
impairment.
Setting – Rehabilitation centers.
Participants – Patients with stroke from five different stroke recovery cohorts.
Interventions – Not applicable.
Main Outcome Measures – A decision tree version of the ARAT (ARAT-DT) was developed using Chi-squared Automated
Interaction Detection (CHAID). In an independent validation subset, criterion validity,
agreement of ARAT-DT with original ARAT scores and score categories, and construct
validity with the Fugl-Meyer upper extremity (FM-UE) score were determined.
Results – In total, 3738 ARAT measurements were available involving 1,425 subjects. CHAID
analysis in the development subset (n=2803) revealed an optimized decision tree with
a maximum of four consecutive items. In the validation dataset (n=935), the ARAT-DT
differed by a mean of 0.19 points (0.3% of the total scale) from the original ARAT
scores (limits of agreement: -5.67 to 6.05). The ARAT-DT demonstrated excellent criterion
validity with the original ARAT scores (ICC=0.99 and ρ=0.99) and scoring categories
(κw=0.97). The ARAT-DT showed very good construct validity with the FM-UE motor scale
(ρ=0.92).
Conclusion – A decision tree version of the ARAT was developed, reducing the maximum number
of items necessary for ARAT administration from 19 to 4. The scores produced by the
decision tree had excellent criterion validity with original ARAT scores.
Key words
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Article Info
Publication History
Accepted:
December 13,
2021
Received in revised form:
December 7,
2021
Received:
September 21,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
