ArticlesThe intra- and interrater reliability of the action research arm test: A practical test of upper extremity function in patients with stroke☆,☆☆,★
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.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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Supported by the Netherlands Organization for Scientific Research (NWO) Council for Medical and Health Research (project no. 904-65-045).
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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.
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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].
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