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 5 different stroke recovery cohorts (N=1425).
Interventions
Not applicable.
Main Outcome Measures
A decision tree version of the ARAT (ARAT-DT) was developed using chi-square automated
interaction detection. 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 Scale score were determined.
Results
In total, 3738 ARAT measurements were available involving 1425 subjects. Chi-square
automated interaction detection analysis in the development subset (n=2803) revealed
an optimized decision tree with a maximum of 4 consecutive items. In the validation
data set (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 (intraclass
correlation coefficient=0.99 and ρ=0.99) and scoring categories (κw=0.97). The ARAT-DT showed very good construct validity with the Fugl-Meyer Upper
Extremity 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.
Keywords
List of abbreviations:
ARAT (Action Research Arm Test), ARAT-DT (Action Research Arm Test decision tree version), CHAID (chi-square automated interaction detection), FM-UE (Fugl-Meyer Upper Extremity Scale), ICC (intraclass correlation coefficient), LoA: limit of agreement (IRT, item response theory), mRS (modified Rankin Scale)To read this article in full you will need to make a payment
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References
- Arm function after stroke: measurement and recovery over the first three months.J Neurol Neurosurg Psychiatry. 1987; 50: 714-719
- The hemiplegic arm after stroke: measurement and recovery.J Neurol Neurosurg Psychiatry. 1983; 46: 521-524
- Association between impairments, self-care ability and social activities 1 year after stroke.Disabil Rehabil. 1999; 21: 372-377
- Probability of regaining dexterity in the flaccid upper limb.Stroke. 2003; 34: 2181-2186
- Barthel index for stroke trials.Stroke. 2011; 42: 1146-1151
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke. 1988; 19: 604-607
- Intense arm rehabilitation therapy improves the modified Rankin Scale score: Association between gains in impairment and function.Neurology. 2021; 96: e1812-e1822
- Connecting upper limb functional stroke recovery to global disability measures: Finding the forest in the trees.Neurology. 2021; 96: 643-644
- Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study.Clin Rehabil. 2005; 19: 404-411
- Standardized measurement of sensorimotor recovery in stroke trials: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable.Int J Stroke. 2017; 12: 451-461
- Consensus-based core set of outcome measures for clinical motor rehabilitation after stroke—a Delphi study.Front Neurol. 2020; 11: 875
- A performance test for assessment of upper limb function in physical rehabilitation treatment and research.Int J Rehabil Res. 1981; 4: 483-492
- A systematic review of the psychometric properties of the Action Research Arm Test in neurorehabilitation.Aust Occup Ther J. 2018; 65: 449-471
- A standardized approach to performing the action research arm test.Neurorehabil Neural Repair. 2008; 22: 78-90
- Validation of the action research arm test using item response theory in patients after stroke.J Rehabil Med. 2006; 38: 375-380
- Rasch validation and predictive validity of the action research arm test in patients receiving stroke rehabilitation.Arch Phys Med Rehabil. 2012; 93: 1039-1045
- Interpreting Action Research Arm Test assessment scores to plan treatment.OTJR (Thorofare N J). 2019; 39: 64-73
- Improving the Action Research Arm test: a unidimensional hierarchical scale.Clin Rehabil. 2002; 16: 646-653
- Overview of classical test theory and item response theory for the quantitative assessment of items in developing patient-reported outcomes measures.Clin Ther. 2014; 36: 648-662
- Analysing the Action Research Arm Test (ARAT): a cautionary tale from the RATULS trial.Int J Rehabil Res. 2021; : 166-169
- An exploratory technique for investigating large quantities of categorical data.J R Stat Soc Ser C Appl Stat. 1980; 29: 119-127
- Item reduction of the Boston Carpal Tunnel Questionnaire using decision tree modeling.Arch Phys Med Rehabil. 2019; 100: 2308-2313
- Item reduction of the patient-rated wrist evaluation using decision tree modelling.Disabil Rehabil. 2020; 42: 2758-2765
- Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: early prediction of functional outcome after stroke: the EPOS cohort study.Stroke. 2010; 41: 745-750
- Is recovery of somatosensory impairment conditional for upper-limb motor recovery early after stroke?.Neurorehabil Neural Repair. 2020; 34: 403-416
- Effects of unilateral upper limb training in two distinct prognostic groups early after stroke: the EXPLICIT-Stroke Randomized Clinical Trial.Neurorehabil Neural Repair. 2016; 30: 804-816
- Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial.Lancet. 2019; 394: 51-62
- International classification of functioning, disability and health: ICF.World Health Organization, Geneva2001
- The intra- and interrater reliability of the action research arm test: a practical test of upper extremity function in patients with stroke.Arch Phys Med Rehabil. 2001; 82: 14-19
- ARM: arm rehabilitation measurement: manual for performance and scoring of the Fugl-Meyer test (arm section), Action Research Arm test, and the Box-and-Block test.Deutscher Wissenschafts-Verlag, Baden-Baden2005
- Predicting recovery potential for individual stroke patients increases rehabilitation efficiency.Stroke. 2017; 48: 1011-1019
- How do Fugl-Meyer Arm motor scores relate to dexterity according to the Action Research Arm Test at 6 months poststroke?.Arch Phys Med Rehabil. 2015; 96: 1845-1849
- The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance.Scand J Rehabil Med. 1975; 7: 13-31
- Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2016; 47: e98-169
- The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties.Neurorehabil Neural Repair. 2002; 16: 232-240
- COSMIN guideline for systematic reviews of patient-reported outcome measures.Qual Life Res. 2018; 27: 1147-1157
- Measurement in medicine: a practical guide.Cambridge University Press, Cambridge2015
- A guideline of selecting and reporting intraclass correlation coefficients for reliability research.J Chiropr Med. 2016; 15: 155-163
- Statistical methods for assessing agreement between two methods of clinical measurement.Lancet. 1986; 327: 307-310
- Measurement of upper-extremity function early after stroke: properties of the action research arm test.Arch Phys Med Rehabil. 2006; 87: 1605-1610
- Agreed definitions and a shared vision for new standards in stroke recovery research: the Stroke Recovery and Rehabilitation Roundtable Taskforce.Neurorehabil Neural Repair. 2017; 31: 793-799
- Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer assessment in minimally impaired upper extremity hemiparesis in stroke.Arch Phys Med Rehabil. 2012; 93 (2373-6.e5)
- Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke.Phys Ther. 2009; 89: 840-850
- Estimating minimal clinically important differences of upper-extremity measures early after stroke.Arch Phys Med Rehabil. 2008; 89: 1693-1700
- The chi-square test of independence.Biochem Med. 2013; 23: 143-149
- The responsiveness of the Action Research Arm Test and the Fugl-Meyer assessment scale in chronic stroke patients.J Rehabil Med. 2001; 33: 110-113
- Predicting improvement in the upper paretic limb after stroke: a longitudinal prospective study.Restor Neurol Neurosci. 2007; 25: 453-460
- Are corrections in accurate arm movements corrective?.Progr Brain Res. 1986; 64: 353-360
- The coupling of arm and finger movements during prehension.Exp Brain Res. 1990; 79: 431-435
- Development of a computerized adaptive testing system of the Fugl-Meyer motor scale in stroke patients.Arch Phys Med Rehabil. 2012; 93: 1014-1020
Article info
Publication history
Published online: January 05, 2022
Accepted:
December 13,
2021
Received in revised form:
December 7,
2021
Received:
September 21,
2021
Footnotes
Supported by the Stichting Kwaliteitsgelden Medisch Specialisten (SKMS, Grant No. 53070331). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The RATULS trial was funded by the National Institutes of Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 11/26/05). The EXPLICIT stroke trial was funded by the Netherlands Organisation for Health Research and Development (ZonMw Grant No. 89000001) and was supported by the European Research Council (ERC) under the European Union's Seventh Framework Programme (FP/2007-2013)/ERC Grant Agreement no. 291339-4D-EEG and grants awarded by the Dutch Brain Foundation. The PROFITS cohort study was funded by the Netherlands Organisation for Health Research and Development (ZonMw Grant No. 104003008).
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
