Assessing the Streamlined Wolf Motor Function Test as an Outcome Measure for Stroke Rehabilitation

 Lots wrong here:

1. Assessments DO NOTHING FOR RECOVERY!
2. Wolf Motor is not objective, so useless for any measurements. Wolf Motor Function Test (WMFT
3. Outcome measures don't get you recovered, so completely fucking useless! You ask the survivor one question; 'Are you fully recovered?' Y/N? And that is the only question needed!

Assessing the Streamlined Wolf Motor Function Test as an Outcome Measure for Stroke Rehabilitation

Ching-yi Wu, ScD, Tiffany Fu, PhD, […], and Hisaaki Ota, PhD+6View all authors and affiliations

Volume 25, Issue 2

https://doi.org/10.1177/1545968310381249

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Abstract

Objective. 

 This study investigates the clinimetric properties of the streamlined Wolf Motor Function Test (WMFT), a 6-item version of the performance time scale of the WMFT. 

Methods. 

The streamlined WMFT, along with 2 criterion measures, the Fugl-Meyer Assessment (FMA) and the Stroke Impact Scale (SIS), were administered to 64 stroke patients before and after a 3-week intervention. Responsiveness was examined using the Wilcoxon signed rank test and standardized response mean (SRM). Criterion-related validity was investigated using the Spearman correlation coefficient (ρ). 

Results. 

The mean score on the baseline FMA upper extremity of the patients was 44.84 (standard deviation = 12.77). The streamlined WMFT and the original performance time scale showed comparable responsiveness (SRM = 0.29 and 0.37, respectively). The concurrent validity of the streamlined WMFT was good (ρ = 0.57-0.69). For predictive validity, the streamlined WMFT showed slightly better association with the criterion measures (ρ = 0.60-0.68) than did the original scale (ρ = 0.56-0.64). 

Conclusions. 

Compared with the original scale, the streamlined WMFT showed improved clinical utility.

Introduction

The 21-item Wolf Motor Function Test (WMFT) was originally developed to assess the effects of constraint-induced movement therapy on the return of upper extremity (UE) movement ability in stroke survivors.¹ It was subsequently modified and contains 17 tasks, including 2 strength-based tasks and 15 function-based tasks, divided into 2 scales: performance time and functional ability.² The reliability and validity of the WMFT have been well established in previous studies. The WMFT had good test-retest reliability^2,3 and criterion validity^3,4 for performance time and functional ability. In addition, interrater reliability of the WMFT was high (range, 0.97-0.99).⁵ This test has been widely used as an outcome measure in stroke motor rehabilitation trials.^6-10

Owing to lengthy administration times, the WMFT was further shortened to 6 tasks in a recent study.¹¹ Although the 6 tasks of the streamlined WMFT had a significant relationship with overall improvement in the Extremity Constraint Induced Therapy Evaluation (EXCITE) trial,¹¹ no study to date has reported the sensitivity of change of this shortened version. To be of practical use in rehabilitation trials, the short form of an outcome measure should not only show reliability and validity but also be sensitive in measuring change within persons over time.¹² That is, the demonstration of sound clinimetric properties of an outcome measure is a priority before its application in clinical trials or in the evaluation of the effects of rehabilitation therapies.^13,14

Because the streamlined WMFT has not been sufficiently validated, the responsiveness and criterion validity of the short form of the WMFT remain unknown. To address the gap, we evaluated the clinimetric properties of the streamlined WMFT in a stroke cohort other than the sample studied in the EXCITE trial. Responsiveness indicates an instrument’s ability to detect the smallest change in score.¹⁵ Furthermore, responsiveness is neither a constant statistic nor a context-free attribute.¹⁶ In other words, responsiveness of an instrument should be described in relation to a particular group of people under certain conditions. Lin et al³ studied the responsiveness of the WMFT during the recovery course of the first 6 months after stroke, but no rehabilitation therapy was specified for the change in WMFT. This study evaluated the responsiveness of the streamlined WMFT in patients with subacute stroke, defined as 3 to 9 months poststroke in the Bogard et al study,¹¹ who had undergone rehabilitation therapies.

As suggested by Bogard et al,¹¹ this study also examined the criterion validity of the streamlined WMFT. Criterion validity includes concurrent validity and predictive validity, which considers the degree of consistency of an instrument with the criterion measures and the ability of an instrument to predict future events.¹⁷ The examination of the concurrent validity of the streamlined WMFT enables researchers to determine if this streamlined version measures the same construct as is assessed by the 17-item WMFT. The streamlined WMFT may be taken as an important tool for guiding clinical decision making for rehabilitation goal planning if it shows a level of predictive validity similar to that of the 17-item WMFT.

The purpose of the present study was therefore to examine the clinimetric domains of the streamlined WMFT, including the responsiveness and validity (concurrent and predictive validity) in a cohort of subacute stroke patients. Because Bogard et al¹¹ suggested that the tasks selected for streamlined WMFT depend on the time poststroke (subacute vs chronic), we used the streamlined WMFT with 6 tasks appropriate for subacute patients.