0. No symptoms at all. 1. No significant disability, despite symptoms; able to carry out all usual duties and activities. 2. Slight disability; unable to carry out all. Four short, simple measures of arm function, suitable for use with patients recovering from acute stroke, are described. These tests are: the Frenchay Arm Test. Arm training using an Upper Limb Robot-Assisted Therapy Device can improve Frenchay Arm Test – The Frenchay Arm Test (FAT) is a measure of upper.
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Tests of upper-extremity motor function used for people following a tst have been described, but reliability and validity psychometric properties of measurements obtained with these tests have not been consistently established. This investigation was performed: Literature searches were done using 2 databases. Reports of 4 psychometric properties were sought: Nine tests met the inclusion criteria of having psychometric properties reported in the literature.
No test had evidence for all 4 psychometric properties.
Only the Nine-Hole Peg Test was supported by 3 out of 4 properties. Most tests had 2 properties supported. Concurrent validity or convergent validity was most frequently described; test-retest reliability was least frequently described. More complete psychometric support is needed for upper-extremity motor function tests applied following a stroke. The absence of psychometric support, however, does not mean that a test has no value. Clinicians are cautioned not to generalize psychometric evidence.
Measurements used to evaluate outcome and performance during and following rehabilitation should have acceptable reliability and validity. Wade, 1 inwas the first author to review upper-extremity motor function tests commonly used in stroke rehabilitation. He reported that adequate tests existed and that these tests should be applied under research and clinical circumstances to establish their strengths and weaknesses.
In his review, he indicated whether the degree of validity, reliability, and sensitivity of tests was known; which test domains were covered eg, impairment or specific [focal] disability ; and whether the test was composed of a battery of tasks.
Frenchay Arm test (FAT) – Allie: Abbreviation / Long Form Info.
His recommendations for using a test were based on the amount of time required to administer the test. Several other review articles, not specific to stroke rehabilitation, have considered hand and arm function tests.
Bear-Lehman and Abreu, 3 indemonstrated the fgenchay need to provide estimates of the validity and reliability of instruments used to measure hand function. They described instruments that measure hand function in terms of range of motion, edema, performance, sensation, dexterity, and physical capacity evaluation. Rudman and Hannah 4 reviewed 4 tests of hand function. None of these previously described reviews demonstrated an extensive search for all available upper-extremity motor function tests, and the tests included were not selected based on a set of predetermined inclusion criteria.
Using a modification of Sackett’s procedures Tab.
Sackett’s levels of evidence are most readily applied to areas of research with large numbers rest studies and with trials of interventions. Therefore, the group that developed the guide characterized available research designs as either randomized controlled trials or quasi-experimental designs. They also considered the amount of published research available and then made recommendations for the use of standardized assessment tools.
Tables in the guide listed investigations in which the validity, reliability, and sensitivity of measurements obtained with various tests of function were examined. Measures of disability and overall motor function were included in these tables, but measures specific to upper-extremity motor function were not included.
Evidence supporting the use of upper-extremity motor function outcome measures, therefore, srm not been systematically freenchay. In this article, a review is presented of published upper-extremity motor function tests used with patients who have sustained a stroke.
Our literature review was restricted to studies of assessment tools that involve direct interpretation of the motor abilities of the affected upper extremity. In our clinic, we have observed that disability-oriented upper-extremity tests can allow for compensatory movements by the unaffected upper extremity.
Therefore, these types of tests were excluded. Tests were considered only if they were functional limitation oriented or measured functional limitations and impairments. In this review, the importance of having an assessment tool supported by published accounts of validity and reliability is discussed.
The purposes of this investigation were: A preliminary PubMed search by a physical therapist EC was completed using a variety of key words related to testing of upper-extremity motor function.
The purposes of this search were to become familiar with relevant literature, to review the quantity and quality of relevant literature, and to make adjustments in key word selection.
The literature was searched from to Only English-language articles were requested. Combinations of the following key words were used: Approximately 2, article titles were identified in the 3 searches. Of this original group, articles were selected to receive more detailed examination. Selection was based on article inclusion criteria of being published in a peer-reviewed journal and having at least one of several design objectives related to upper-extremity motor function tests.
A few discrepancies occurred between the lists generated in the 2 searches. In these cases, we conferred until agreement to include or exclude the article was reached. Appendix 2 describes in more detail the inclusion criteria for this stage of the literature review. After examination of these articles, we identified 31 different tests that were used for upper-extremity motor function. A set of inclusion criteria related to the nature of the tests and how they were applied was then used to identify a subset of 13 articles.
These articles not only described the use of upper-extremity motor function tests on people who had strokes, but also presented data that could be used to evaluate the psychometric properties of the tests. Additional searches were performed using the 31 named tests as key words to be sure that other publications had not been missed in the 2 main literature searches.
Tests that did not meet the inclusion criteria are listed in Table 2. Nine tests that qualified are described in Table 3. Tests Excluded From Analysis a.
Tests described in the articles were recorded in a checklist data field. Therefore, all tests referenced or used in the studies described in the articles could be added as the project continued. Inclusion criteria were applied to each test from the checklist to establish the list of appropriate tests. Comment fields were used to collect information regarding psychometric properties and statistical analyses.
Upper-extremity motor function tests examined for this review were assigned to ordinal categories levels I, II, and III according to how many psychometric properties had demonstrable published results for those tests within a group of patients with strokes. If 2 of the 3 psychometric properties were supported by significant correlations, the test was assigned to level II. If only one of the psychometric properties was supported by a significant correlation, the test was assigned to level III.
For some studies, both correlations and significance were reported, and, for some studies, the principal author EC calculated significance values based on reported correlations and the number of subjects in a study. If the PV of a test is established, the clinical utility of that test is improved. Therefore, to give credit to tests for which PV was determined, this finding also was reported.
Predictive validity could have been examined to predict placement after discharge, use of assistive device, functional independence during inpatient stay, and so on.
These predictions may be projected to a year hest stroke onset. Predictive validity only considers conditions at the time of testing. Many other factors may influence the long-term performance capabilities of a patient. This section describes the tests according to the levels to which they were assigned, from the highest level most psychometric support or level Frenhcay to the lowest level least psychometric support or level III.
Table 3 documents the psychometric evidence for each test. Table 4 summarizes levels to which the tests were assigned. Ranked Levels of Evidence a. The Nine-Hole Peg Test had evidence in 3 psychometric categories: However, which r values were specifically for IRR between different raters [ie, clinicians] or TRT comparing first scores of raters with second scores of the same raters for the same patients could not be determined from the article.
Loewen and Anderson 16 and Poole and Whitney 19 separated the Motor Assessment Scale into 3 rfenchay components or subscales and determined IRR for each subscale.
Both pairs of investigators used the same subscales: Poole and Whitney described IRR between afm raters using 24 subjects and Spearman correlation coefficients.
The Spearman correlation coefficients were 1. Loewen and Anderson described IRR among 14 raters using 7 subjects and percentage of agreement with kappa coefficients.
Percentages of agreement were InLoewen and Anderson, 17 using Spearman correlations, performed additional frenchat testing to examine the predictive ability of the Motor Assessment Scale. Results were obtained by examining scores obtained for the following components of the upper-extremity subscale of the test: No evidence, other than that reported by Collin and Wade, was found to establish the Rivermead Motor Assessment as having validity or reliability for patients following a stroke.
The correlations between frfnchay Motricity Index upper-extremity subscale scores and the Rivermead Motor Assessment upper-extremity tesst scores across 3 time periods 6, 12, and 18 weeks after stroke were.
They found that the Motricity Index was better than the Nine-Hole Peg Test at identifying subjects who would score above zero on the Frenchay Arm Test 6 months after initial assessment. The ICC value was established at. Convergent validity of data obtained with the Action Research Arm Test as compared with data obtained with the Modified Motor Assessment Chart and the Motricity Index was established at. InGowland et al 12 published a study of the reliability of data obtained for independent components of the impairment inventory.
Impairment inventory components included measures of shoulder pain, postural control, and arm upper-extremityhand, leg, and foot function. Sanford et al 20 repeated Fugl-Meyer Sensorimotor Assessment reliability studies on patients during rehabilitation 6 days to 6 months following a stroke and found an ICC value of.
Sanford et al did not report the mean time teat onset frennchay stroke. The Modified Motor Assessment Chart utilizes subscales of upper- and lower-extremity function and standing leg movements; it is a modified tedt of the Fugl-Meyer Sensorimotor Assessment. This test requires the frrenchay to perform one-handed activities; both arms are evaluated separately.
Arm function after stroke: measurement and recovery over the first three months.
The Motor Club Assessment was first described as an upper-extremity motor function test for people following a stroke by Ashburn.
Sunderland et al 21 used the Motor Club Assessment to examine grip force as a prognostic tool. They reported using the Motor Club Assessment to establish grip force as a predictive measure of outcome at 6 months following a stroke, but a secondary finding also was reported when they used the Motor Club Assessment to predict performance on the Frenchay Arm Test. Collin and Wade’s article was the first to report use of the Rivermead Motor Assessment upper-extremity subscale with this diagnosis.
Disability-oriented tests were not included in our review because these tests permit use of compensatory activity. We believe a measurement of motor recovery is difficult to obtain when an uninvolved extremity can compensate for deficits of the involved side.