Responsiveness and validity of three dexterous function measures in stroke rehabilitation.

In this study, we compared the responsiveness and validity of the Box and Block Test (BBT), the Nine-Hole Peg Test (NHPT), and the Action Research Arm Test (ARAT). We randomized 59 patients with stroke into one of three rehabilitation treatments for 3 weeks. We administered six outcome measures (BBT, NHPT, ARAT, Fugl-Meyer Assessment [FMA], Motor Activity Log [MAL], and Stroke Impact Scale [SIS] hand function domain) pretreatment and posttreatment. We used the standardized response mean (SRM) to examine responsiveness and the Spearman rank correlation coefficient (rho) to examine concurrent validity. The BBT, NHPT, and ARAT were moderately responsive to change and not significantly different (SRM = 0.64-0.79). The correlations within the BBT, NHPT, and ARAT were moderate to good at pretreatment (rho = -0.55 to -0.80) and posttreatment (rho = -0.57 to -0.71). The BBT and ARAT showed fair to moderate correlations with the FMA, MAL, and SIS hand function domain at pretreatment and posttreatment (rho = 0.31-0.59), whereas the NHPT demonstrated low to fair correlations with the FMA and MAL (rho = -0.16 to -0.33) and moderate correlations with the SIS hand function domain (rho = -0.58 to -0.66). Our results indicate that the BBT, NHPT, and ARAT are suitable to detect changes over time. While simultaneously considering the responsiveness and validity attributes, the BBT and ARAT can be considered more appropriate for evaluating dexterous function than the NHPT. Further studies with larger samples are needed to validate these findings.

[1]  T. Platz,et al.  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 , 2005, Clinical rehabilitation.

[2]  Hui Chen,et al.  Test-Retest Reproducibility and Smallest Real Difference of 5 Hand Function Tests in Patients With Stroke , 2009, Neurorehabilitation and neural repair.

[3]  M. Rabadi,et al.  Comparison of the action research arm test and the Fugl-Meyer assessment as measures of upper-extremity motor weakness after stroke. , 2006, Archives of physical medicine and rehabilitation.

[4]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[5]  Robert Tibshirani,et al.  An Introduction to the Bootstrap , 1994 .

[6]  Jerome Danoff,et al.  Evidence-based rating of upper-extremity motor function tests used for people following a stroke. , 2004, Physical therapy.

[7]  R. Kane,et al.  Manual Dexterity as a Correlate of Dependency in the Elderly , 1989, Journal of the American Geriatrics Society.

[8]  R L Hewer,et al.  Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator. , 1989, Journal of neurology, neurosurgery, and psychiatry.

[9]  N. Mayo,et al.  Inferring quality of life from performance-based assessments , 2000, Disability and rehabilitation.

[10]  Ching-yi Wu,et al.  Responsiveness and Validity of Three Outcome Measures of Motor Function After Stroke Rehabilitation , 2009, Stroke.

[11]  H. Vet,et al.  Clinimetric Properties of the Motor Activity Log for the Assessment of Arm Use in Hemiparetic Patients , 2004, Stroke.

[12]  P. Stratford,et al.  Does parallel item content on WOMAC's Pain and Function Subscales limit its ability to detect change in functional status? , 2004, BMC musculoskeletal disorders.

[13]  P. Lachenbruch.  Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[14]  Jeffery J. Summers,et al.  Bilateral movement training and stroke rehabilitation: A systematic review and meta-analysis , 2006, Journal of the Neurological Sciences.

[15]  Joanne M Wagner,et al.  Measurement of upper-extremity function early after stroke: properties of the action research arm test. , 2006, Archives of physical medicine and rehabilitation.

[16]  E. V. van Sonderen,et al.  Responsiveness and validity of 3 outcome measures of motor function after stroke rehabilitation. , 2010, Stroke.

[17]  Sharon Wood-Dauphinee,et al.  The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial , 2006, Clinical rehabilitation.

[18]  R. Hébert,et al.  Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. , 1994, Archives of physical medicine and rehabilitation.

[19]  S. Wolf,et al.  Can the Wolf Motor Function Test be Streamlined? , 2009, Neurorehabilitation and neural repair.

[20]  Yuh Jang,et al.  Minimal Detectable Change and Clinically Important Difference of the Wolf Motor Function Test in Stroke Patients , 2009, Neurorehabilitation and neural repair.

[21]  Subashan Perera,et al.  Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale. , 2003, Archives of physical medicine and rehabilitation.

[22]  G H Guyatt,et al.  Responsiveness and validity in health status measurement: a clarification. , 1989, Journal of clinical epidemiology.

[23]  Yen-ho Wang,et al.  Minimal Detectable Change and Clinically Important Difference of the Stroke Impact Scale in Stroke Patients , 2010, Neurorehabilitation and neural repair.

[24]  R. Teasell,et al.  Outcome Assessment in Randomized Controlled Trials of Stroke Rehabilitation , 2007, American journal of physical medicine & rehabilitation.

[25]  A. Sunderland,et al.  Arm function after stroke: measurement and recovery over the first three months. , 1987, Journal of neurology, neurosurgery, and psychiatry.

[26]  V. Mathiowetz,et al.  Adult norms for the Box and Block Test of manual dexterity. , 1985, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[27]  Catherine E Lang,et al.  Relating Movement Control at 9 Upper Extremity Segments to Loss of Hand Function in People with Chronic Hemiparesis , 2007, Neurorehabilitation and neural repair.

[28]  Catherine E Lang,et al.  Relationships and Responsiveness of Six Upper Extremity Function Tests During the First Six Months of Recovery After Stroke , 2009, Journal of neurologic physical therapy : JNPT.

[29]  J. H. van der Lee,et al.  The responsiveness of the Action Research Arm test and the Fugl-Meyer Assessment scale in chronic stroke patients. , 2001, Journal of rehabilitation medicine.

[30]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[31]  G. Kwakkel,et al.  Predicting improvement in the upper paretic limb after stroke: a longitudinal prospective study. , 2007, Restorative neurology and neuroscience.

[32]  G. Kwakkel,et al.  Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial , 1999, The Lancet.

[33]  S. Lamb,et al.  Effective Measurement of the Functional Progress of Stroke Clients , 2005 .

[34]  Anna Tuke,et al.  Constraint-induced movement therapy: a narrative review , 2008 .

[35]  S. Studenski,et al.  Measuring Stroke Impact With the Stroke Impact Scale: Telephone Versus Mail Administration in Veterans With Stroke , 2005, Medical care.

[36]  Alexander W Dromerick,et al.  Relationships between upper-limb functional limitation and self-reported disability 3 months after stroke. , 2006, Journal of rehabilitation research and development.

[37]  R. Lyle.  A performance test for assessment of upper limb function in physical rehabilitation treatment and research , 1981, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[38]  G. Kwakkel,et al.  Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. , 2003, Stroke.

[39]  V. Mathiowetz,et al.  Adult Norms for the Nine Hole Peg Test of Finger Dexterity , 1985 .

[40]  J. Sinacore,et al.  Self Report and Performance‐Based Hand Function Tests as Correlates of Dependency in the Elderly , 1991, Journal of the American Geriatrics Society.

[41]  Nancy E Mayo,et al.  Upper-limb function and recovery in the acute phase poststroke. , 2005, Journal of rehabilitation research and development.