The intra- and interrater reliability of the action research arm test: A practical test of upper extremity function in patients with stroke

doi:10.1053/apmr.2001.18668

Archives of Physical Medicine and Rehabilitation

Volume 82, Issue 1, January 2001, Pages 14-19

https://doi.org/10.1053/apmr.2001.18668 Get rights and content

Abstract

van der Lee JH, de Groot V, Beckerman H, Wagenaar RC, Lankhorst GJ, Bouter LM. 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;82:14-9. Objectives: To determine the intra- and interrater reliability of the Action Research Arm (ARA) test, to assess its ability to detect a minimal clinically important difference (MCID) of 5.7 points, and to identify less reliable test items. Design: Intrarater reliability of the sum scores and of individual items was assessed by comparing (1) the ratings of the laboratory measurements of 20 patients with the ratings of the same measurements recorded on videotape by the original rater, and (2) the repeated ratings of videotaped measurements by the same rater. Interrater reliability was assessed by comparing the ratings of the videotaped measurements of 2 raters. The resulting limits of agreement were compared with the MCID. Patients: Stratified sample, based on the intake ARA score, of 20 chronic stroke patients (median age, 62yr; median time since stroke onset, 3.6yr; mean intake ARA score, 29.2). Main Outcome Measures: Spearman's rank-order correlation coefficient (Spearman's rho); intraclass correlation coefficient (ICC); mean difference and limits of agreement, based on ARA sum scores; and weighted kappa, based on individual items. Results: All intra- and interrater Spearman's rho and ICC values were higher than.98. The mean difference between ratings was highest for the interrater pair (.75; 95% confidence interval,.02-1.48), suggesting a small systematic difference between raters. Intrarater limits of agreement were −1.66 to 2.26; interrater limits of agreement were −2.35 to 3.85. Median weighted kappas exceeded.92. Conclusion: The high intra- and interrater reliability of the ARA test was confirmed, as was its ability to detect a clinically relevant difference of 5.7 points. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Subjects

A subsample of 20 patients involved in a randomized clinical trial (RCT) on the effectiveness of forced-use treatment in chronic stroke patients served as the study population in the reliability study.¹² The randomized clinical trial included 66 subjects who met the following inclusion criteria: (1) a history of a single stroke, at least 1 year previously, resulting in hemiparesis on the dominant side; (2) a minimum of 20° of active extension in the wrist and 10° of finger extension; (3) ARA

Results

The sample included 20 patients (9 men, 11 women; median age, 62yr), with a median time since stroke of 3.6 years. The baseline characteristics are presented in table 1.

Table 1: Intake Characteristics of Subjects (n = 20)

Median age in yr (IQR)	62 (52.5-71.8)
Median years since stroke (IQR)	3.6 (2.5-4.9)
Women	11 (55%)
Diagnosis of hemorrhage	3 (15%)
Left-sided hemiparesis	6 (30%)
Sensory disorders present	10 (50%)
Hemineglect present	2 (10%)
Intake ARA score*	29.2 ± 12.5
Intake FMA score*	49.2 ± 9.9
*Intake (ie,

Discussion

Although the items on the ARA test are scored on an ordinal 4-point scale, performance on this test is usually expressed as a sum score, which is generally treated as an interval scale ranging from 0 to 57.1, 2, 3, 4, 6, 7, 8 Statistical methods to estimate reliability for ordinal scales are different from those for interval or continuous scales, although the underlying statistical principles are similar.¹⁰ Because the sum score of the ARA test is used in the analysis of clinical trials, this

Conclusion

The present study confirms the high intra- and interrater reliability of the ARA test in a population of chronic stroke patients with a moderate residual loss of arm function. It is capable of detecting a difference of 10% of its maximum possible sum score of 57 points, which is considered to be clinically relevant. To make a clear distinction between scores 2 and 3, it is recommended that an explicit criterion be applied to assess patients' contact with the back of the chair, in combination

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This study aimed to compare robotic rehabilitation approaches incorporating either resistance training (RET) or active-assisted training (AAT) using the same rehabilitation robot in people with stroke and moderate impairment.
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To investigate the efficacy of graded motor imagery therapy (GMI) and repetitive transcranial magnetic stimulation (rTMS) on upper extremity function alone and in combination in patients with stroke.
This was a prospective randomized controlled trial.
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Participants (N=56) were randomized into GMI (n=19), rTMS (n=18), or combined groups (n=19).
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The therapy consists of two sequential interventions, lasting until the patient shows no further motor improvement, for a minimum of 11 sessions each. The first phase involves a brain-computer interface governing an exoskeleton and multi-channel functional electrical stimulation enabling full upper-limb movements. The second phase adds anodal transcranial direct current stimulation of the motor cortex of the lesioned hemisphere. Clinical, electrophysiological, and neuroimaging examinations are performed before, between, and after the two interventions (T0, T1, and T2). This case report presents the results from the first patient of the study.
The primary outcome (i.e., 4-point improvement in the Fugl-Meyer assessment of the upper extremity) was met in the first patient, with an increase from 6 to 11 points between T0 and T2. This improvement was paralleled by changes in motor-network structure and function. Resting-state and transcranial magnetic stimulation-evoked electroencephalography revealed brain functional changes, and magnetic resonance imaging (MRI) measures detected structural and task-related functional changes.
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^☆: Supported by the Netherlands Organization for Scientific Research (NWO) Council for Medical and Health Research (project no. 904-65-045).

^☆☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the authors is/are associated.

^★: Reprint requests to Johanna H. Van der Lee, MD, Dept of Rehabilitation Medicine, University Hospital Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands, e-mail: [email protected].

^{NO LABEL}: a. SPSS, Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

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ArticlesThe intra- and interrater reliability of the action research arm test: A practical test of upper extremity function in patients with stroke☆,☆☆,★

Abstract

Section snippets

Subjects

Results

Discussion

Conclusion

Lancet

J Chronic Dis

Pain

Arch Phys Med Rehabil

The functional recovery of stroke: a comparison between neuro-developmental treatment and the Brunnstrom method

Scand J Rehabil Med

Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single blind, randomized, controlled multicenter trial

Stroke

Electrical stimulation of wrist extensors in poststroke hemiplegia

Stroke

A performance test for assessment of upper limb function in physical rehabilitation treatment and research

Int J Rehabil Res

Measuring recovery of arm-hand function in stroke patients: a comparison of the Brunnstrom-Fugl-Meyer test and the Action Research Arm test

Physiother Can

Articles
The intra- and interrater reliability of the action research arm test: A practical test of upper extremity function in patients with stroke☆,☆☆,★