Development and Rasch Validation of an Observational Assessment Tool of Upper Limb Functional Impairment in Stroke Survivors: Functional Assessment Test for Upper Limb

Published:November 01, 2022DOI:



      To develop and validate a quick observational clinical tool, the Functional ASsessment Test for Upper Limb (FAST-UL), for the evaluation of upper limb impairment in goal-directed functional-oriented motor tasks after stroke.


      Observational, cross-sectional, psychometric study.


      Inpatient and outpatient rehabilitation clinic.


      A total of 188 post-stroke survivors (mean age 65.2±17.7 years, 61% men, 48% with ischemic stroke and 66% in the sub-acute phase; N=188).


      Not applicable.

      Main Outcome Measures

      Principal component analysis and Rasch analysis through a Partial Credit Model were used to assess the structure and psychometric properties of the 5 items of the FAST-UL (Hand to Mouth [HtM], Reach to Target, Prono-Supination, Grasp and Release, and Pinch and Release [PaR]).


      The Cronbach's α equal to 0.96 was indicative of an acceptable internal consistency; the reliability, as measured through the Person Separation Reliability equal to 0.87, was good. The FAST-UL tool was unidimensional. All the FAST-UL items were found to fit well the Rasch measurement model. The easiest to perform FAST-UL item was the HtM movement while the most difficult was the PaR movement.


      The FAST-UL is a quick, easy-to-administer observational assessment tool of upper limb motor impairment in post-stroke survivors with good item-level psychometric properties.


      List of abbreviations:

      FAST-UL (Functional Assessment Test for Upper Limb), GaR (Grasp and Release), HtM (Hand to Mouth), ICF (International Classification of Functioning), MnSq (mean square standardized residuals), PaR (Pinch and Release), PS (Prono-supination), RtT (Reach to Target), UL (upper limb)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Langhorne P
        • Bernhardt J
        • Kwakkel G.
        Stroke rehabilitation.
        Lancet. 2011; 377: 1693-1702
        • Demers M
        • Levin MF.
        Do activity level outcome measures commonly used in neurological practice assess upper-limb movement quality?.
        Neurorehabil Neural Repair. 2017; 31: 623-637
        • Murphy MA
        • Häger CK.
        Kinematic analysis of the upper extremity after stroke—how far have we reached and what have we grasped?.
        Phys Ther Rev. 2015; 20: 137-155
        • Clark B
        • Whitall J
        • Kwakkel G
        • Mehrholz J
        • Ewings S
        • Burridge J.
        The effect of time spent in rehabilitation on activity limitation and impairment after stroke.
        Cochrane database Syst Rev. 2021; 10CD012612
        • Kostanjsek N.
        Use of The International Classification of Functioning, Disability and Health (ICF) as a conceptual framework and common language for disability statistics and health information systems.
        BMC Public Health. 2011; 11: S3
        • Lang CE
        • Bland MD
        • Bailey RR
        • Schaefer SY
        • Birkenmeier RL.
        Assessment of upper extremity impairment, function, and activity after stroke: foundations for clinical decision making.
        J Hand Ther. 2013; 26: 104-115
        • Gor-García-Fogeda MD
        • Molina-Rueda F
        • Cuesta-Gómez A
        • Carratalá-Tejada M
        • Alguacil-Diego IM
        • Miangolarra-Page JC
        Scales to assess gross motor function in stroke patients: a systematic review.
        Arch Phys Med Rehabil. 2014; 95: 1174-1183
        • Levin MF
        • Hiengkaew V
        • Nilanont Y
        • et al.
        Relationship between clinical measures of upper limb movement quality and activity poststroke.
        Neurorehabil Neural Repair. 2019; 33: 432-441
        • Schwarz A
        • Bhagubai MMC
        • Nies SHG
        • et al.
        Characterization of stroke-related upper limb motor impairments across various upper limb activities by use of kinematic core set measures.
        J Neuroeng Rehabil. 2022; 19: 2
        • Zonjee VJ
        • Selles RW
        • Roorda LD
        • et al.
        Reducing the number of test items of the Action Research Arm Test post stroke: a decision tree analysis.
        Arch Phys Med Rehabil. 2022; 103: 1582-1591
        • Bernhardt J
        • Bate PJ
        • Matyas TA.
        Accuracy of observational kinematic assessment of upper-limb movements.
        Phys Ther. 1998; 78: 259-270
        • Schwarz A
        • Kanzler CM
        • Lambercy O
        • Luft AR
        • Veerbeek JM.
        Systematic review on kinematic assessments of upper limb movements after stroke.
        Stroke. 2019; 50: 718-727
        • Levin MF
        • Desrosiers J
        • Beauchemin D
        • Bergeron N
        • Rochette A
        Development and validation of a scale for rating motor compensations used for reaching in patients with hemiparesis: the reaching performance scale.
        Phys Ther. 2004; 84: 8-22
        • Subramanian SK
        • Baniña MC
        • Turolla A
        • Levin MF.
        Reaching performance scale for stroke—test-retest reliability, measurement error, concurrent and discriminant validity.
        PM R. 2022; 14: 337-347
        • Vianna de Andrade FPP
        • Padula RS
        • Binda AC
        • da Silva ML
        • SR Alouche
        Measurement properties of the reaching performance scale for stroke.
        Disabil Rehabil. 2021; 43: 1171-1175
        • McKenzie A
        • Dodakian L
        • See J
        • et al.
        Validity of robot-based assessments of upper extremity function.
        Arch Phys Med Rehabil. 2017; 98 (e2): 1969-1976
        • Jarque-Bou NJ
        • Atzori M
        • Müller H.
        A large calibrated database of hand movements and grasps kinematics.
        Sci Data. 2020; 7: 12
        • Shirota C
        • Balasubramanian S
        • Melendez-Calderon A.
        Technology-aided assessments of sensorimotor function: current use, barriers and future directions in the view of different stakeholders.
        J Neuroeng Rehabil. 2019; 16: 1-17
        • Caimmi M
        • Guanziroli E
        • Malosio M
        • et al.
        Normative data for an instrumental assessment of the upper-limb functionality.
        Biomed Res Int. 2015; 2015484131
        • Caimmi M
        • Carda S
        • Giovanzana C
        • et al.
        Using kinematic analysis to evaluate constraint-induced movement therapy in chronic stroke patients.
        Neurorehabil Neural Repair. 2008; 22: 31-39
        • Lambercy O
        • Dovat L
        • Yun H
        • et al.
        Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study.
        J Neuroeng Rehabil. 2011; 8: 63
        • Hefter H
        • Jost WH
        • Reissig A
        • Zakine B
        • Bakheit AM
        • Wissel J.
        Classification of posture in poststroke upper limb spasticity: a potential decision tool for botulinum toxin A treatment?.
        Int J Rehabil Res. 2012; 35: 227-233
        • Stival F
        • Michieletto S
        • Cognolato M
        • Pagello E
        • Müller H
        • Atzori M.
        A quantitative taxonomy of human hand grasps.
        J Neuroeng Rehabil. 2019; 16: 28
        • Jarque-Bou NJ
        • Scano A
        • Atzori M
        • Müller H.
        Kinematic synergies of hand grasps: a comprehensive study on a large publicly available dataset.
        J Neuroeng Rehabil. 2019; 16: 63
        • Liu Y
        • Jiang L
        • Liu H
        • Ming D.
        A systematic analysis of hand movement functionality: qualitative classification and quantitative investigation of hand grasp behavior.
        Front Neurorobot. 2021; 15: 1-14
        • Lan Y
        • Yao J
        • Dewald JPA.
        The impact of shoulder abduction loading on volitional hand opening and grasping in chronic hemiparetic stroke.
        Neurorehabil Neural Repair. 2017; 31: 521-529
      1. Patrick A, et al. eRm: Extended Rasch. 2021.

        • Tesio L.
        Measuring behaviours and perceptions: Rasch analysis as a tool for rehabilitation research.
        J Rehabil Med. 2003; 35: 105-115
        • Bland JM
        • Altman DG.
        Cronbach's alpha.
        BMJ. 1997; 314: 572
        • Andrich D.
        An index of person separation in latent trait theory, the traditional KR20 index, and the Guttman scale response pattern.
        Educ Res Perspect. 1982; 9: 95-104
        • Christensen KB
        • Makransky G
        • Horton M.
        Critical values for Yen's Q(3): identification of local dependence in the Rasch model using residual correlations.
        Appl Psychol Meas. 2017; 41: 178-194
        • Marais I
        • Andrich D.
        Formalizing dimension and response violations of local independence in the unidimensional Rasch model.
        J Appl Meas. 2008; 9: 200-215
        • Woodbury ML
        • Velozo CA
        • Richards LG
        • Duncan PW.
        Rasch analysis staging methodology to classify upper extremity movement impairment after stroke.
        Arch Phys Med Rehabil. 2013; 94: 1527-1533
        • Pollock A
        • Baer G
        • Campbell P
        • et al.
        Physical rehabilitation approaches for the recovery of function and mobility following stroke.
        Cochrane Database Syst Rev. 2014; 2014CD001920
        • Mawase F
        • Cherry-Allen K
        • Xu J
        • Anaya M
        • Uehara S
        • Celnik P.
        Pushing the rehabilitation boundaries: hand motor impairment can be reduced in chronic stroke.
        Neurorehabil Neural Repair. 2020; 34: 733-745
        • Hijikata N
        • Kawakami M
        • Ishii R
        • et al.
        Item difficulty of Fugl-Meyer assessment for upper extremity in persons with chronic stroke with moderate-to-severe upper limb impairment.
        Front Neurol. 2020; 11577855
        • Lang CE
        • Wagner JM
        • Edwards DF
        • Sahrmann SA
        • Dromerick AW.
        Recovery of grasp versus reach in people with hemiparesis poststroke.
        Neurorehabil Neural Repair. 2006; 20: 444-454
        • Schambra HM
        • Parnandi A
        • Pandit NG
        • Uddin J
        • Wirtanen A
        • Nilsen DM.
        A taxonomy of functional upper extremity motion.
        Front Neurol. 2019; 10: 857
        • Schwarz A
        • Veerbeek JM
        • Held JPO
        • Buurke JH
        • Luft AR.
        Measures of interjoint coordination post-stroke across different upper limb movement tasks.
        Front Bioeng Biotechnol. 2020; 8620805
        • Fugl-Meyer AR
        • Jääskö L
        • Leyman I
        • Olsson S
        • Steglind S.
        The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance.
        Scand J Rehabil Med. 1975; 7: 13-31
        • Carr JH
        • Shepherd RB
        • Nordholm L
        • Lynne D
        Investigation of a new motor assessment scale for stroke patients.
        Phys Ther. 1985; 65: 175-180
        • Ahmed S
        • Mayo NE
        • Higgins J
        • Salbach NM
        • Finch L
        • Wood-Dauphinée SL.
        The Stroke Rehabilitation Assessment of Movement (STREAM): a comparison with other measures used to evaluate effects of stroke and rehabilitation.
        Phys Ther. 2003; 83: 617-630
        • Demeurisse G
        • Demol O
        • Robaye E.
        Motor evaluation in vascular hemiplegia.
        Eur Neurol. 1980; 19: 382-389
        • Santisteban L
        • Térémetz M
        • Bleton J-P
        • Baron J-C
        • Maier MA
        • Lindberg PG.
        Upper limb outcome measures used in stroke rehabilitation studies: a systematic literature review.
        PLoS One. 2016; 11: 1-16
        • Kanzler CM
        • Schwarz A
        • Held JPO
        • Luft AR
        • Gassert R
        • Lambercy O.
        Technology-aided assessment of functionally relevant sensorimotor impairments in arm and hand of post-stroke individuals.
        J Neuroeng Rehabil. 2020; 17: 128
        • Van de Winckel A
        • Feys H
        • van der Knaap S
        • et al.
        Can quality of movement be measured? Rasch analysis and inter-rater reliability of the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES).
        Clin Rehabil. 2006; 20: 871-884
        • Singer B
        • Garcia-Vega J.
        The Fugl-Meyer upper extremity scale.
        J Physiother. 2017; 63: 53