Measurement Properties of Streamlined Wolf Motor Function Test in Patients at Subacute to Chronic Stages After Stroke

 

 You can see for yourself that nothing in this Wolf Motor Test actually gets you recovered.  To me this type of testing is useless except you'll have to consent since it probably is needed to get insurance to pay. To me it would be much more useful to spend my time doing protocol repetitions leading to recovery than this shit. So for that reason alone this interater reliability does not matter at all. Please talk to survivors sometime and see what they want out of research and stroke rehab. Not this crapola! 

I would always get a zero on use of my left arm/hand. There is zero point in even trying until my spasticity is cured!

Wolf Motor Function Test (WMFT)

The latest here: 

Measurement Properties of Streamlined Wolf Motor Function Test in Patients at Subacute to Chronic Stages After Stroke

>Chen Ching-yi ScD,[…], and Yanning MEd +5 View all authors and affiliations Volume 9

https://doi.org/10.1177/1545968314526643 PDF/EPUBInformation, rights and permissionsMetrics and citationsFigures and tables

Abstract

Background
Previous research using the streamlined Wolf Motor Function Test (SWMFT) has focused either on the 3- to 9-month period or on the >12-month period after stroke and lacked the information for those at 9 to 12 months. Whether SWMFT scores reflect motor deficit and recovery from early to late stages after stroke remains unclear.  

Objective

 A retrospective study using the Functional Ability Scale (FAS) was conducted to evaluate whether all SWMFTs items measure the poststroke recovery of upper extremity (UE) motor function and if they could be used for patients within 9 to 12 months after a stroke. 

Methods.  

Rasch analysis was conducted, and data were drawn from patients 3 months to years after a stroke.  

Results. 

The continuum of UE motor function in SWMFT-FAS was supported. Subacute patients had the best motor function, followed by the 9- to 12-month group, and then chronic patients. Variation in UE motor function was large (2.35-2.72 logits), and motor abilities of these 3 groups overlapped. The 8 SWMFT items could target a broad range of UE motor function, from −8.28 to 7.80 logits. The average difficulty of these 8 items also matched the UE motor ability of the subgroup at 9 to 12 months after stroke, and individual versions of the SWMFT performed well to assess the motor ability of this group. 

Conclusions. 

The SWMFTs had sound hierarchical properties. The SWMFT-Chronic or the SWMFT-Subacute could be used to evaluate UE function of this subgroup at 9 to 12 months after stroke.

1 Approximately 50% of stroke survivors have some upper extremity (UE) dysfunction,2highlighting the need to study rehabilitation training for UE dysfunction. With the continuing emphasis on evidence-based practices in health care, evaluation of existing measures is critical, and knowing that assessment scores can place patients on a continuum from low to high functional status and reflect progress of patients during treatment has become increasingly pertinent. The Wolf Motor Function Test (WMFT)5 is a widely used measure to assess UE motor function after stroke. This scale was developed initially to evaluate UE performance in chronic patients after stroke receiving forced use treatment of hemiplegic UE. The most current version of the scale includes 17 items,6 comprising 15 function-based tasks and 2 strength-based tasks used to assess the time for completing individual tasks (termed WMFT-TIME), the quality of implementing each task, and strength. The present study focuses on the quality of performance on the WMFT only.The WMFT–Functional Ability Scale (FAS) is specific for evaluating the quality of UE performance in each functional task. A 6-point rating scale is used in which 0 indicates “no attempt to use the affected arm” and 5 shows “movement of affected arm that appears to be normal.” (See Table 1 for detailed descriptions.) Research has recognized high interrater and test-retest reliability of the WMFT-FAS and high internal consistency.7-9 With regard to concurrent and predictive validity, the WMFT-FAS demonstrated a moderate to good relation with the Fugl-Meyer Assessment9,10 and was good to excellent with the UE subscale of the Stroke Rehabilitation Assessment of Movement.9 Studies by Woodbury et al11 and Wolf et al6 further concluded that the WMFT-FAS could differentiate patients with higher UE motor function from those with lower function. Given the excellent reliability6-9 and validity,9-11 use of the WMFT-FAS has been extended to investigate the effectiveness of robotic therapy,12 bilateral arm training,13 and mirror therapy.14

Table 1. Descriptions of the Functional Ability Scale.

0 The participant did not attempt to initiate the task 

using the affected arm. 

1 Attempted to use the affected arm, but it seemed 

not to function. In unilateral tasks, the unaffected 

arm might have been used to help the affected arm. 

2 Attempted to use the affected arm with assistance 

from the unaffected arm for minor adjustments 

or changes of position, requiring more than 2 

attempts to complete or completing a task slowly. 

In bilateral tasks, the affected arm served only as a 

helper. 

3 Only the affected arm was involved, but movements 

were limited or performed slowly and with much 

effort. 

4 Only the affected arm was involved in a task. 

Performance was close to normal, but movements 

were slightly slower and may have lacked precision, 

fine coordination, or fluidity. 

5 Only the affected arm was involved and functioned 

nearly normally

The participant did not attempt to initiate the task using the affected arm. 1 Attempted to use the affected arm, but it seemed not to function. In unilateral tasks, the unaffected arm might have been used to help the affected arm. 2 Attempted to use the affected arm with assistance from the unaffected arm for minor adjustments or changes of position, requiring more than 2 attempts to complete or completing a task slowly. In bilateral tasks, the affected arm served only as a helper. 3 Only the affected arm was involved, but movements were limited or performed slowly and with much effort. 4 Only the affected arm was involved in a task. Performance was close to normal, but movements were slightly slower and may have lacked precision, fine coordination, or fluidity. 5 Only the affected arm was involved and functioned nearly normally

Ratings	Description

1Attempted to use the affected arm, but it seemed not to function. In unilateral tasks, the unaffected arm might have been used to help the affected arm.2Attempted to use the affected arm with assistance from the unaffected arm for minor adjustments or changes of position, requiring more than 2 attempts to complete or completing a task slowly. In bilateral tasks, the affected arm served only as a helper.3Only the affected arm was involved, but movements were limited or performed slowly and with much effort.4Only the affected arm was involved in a task. Performance was close to normal, but movements were slightly slower and may have lacked precision, fine coordination, or fluidity.5Only the affected arm was involved and functioned nearly normally.

To reduce the burden of administration and provide the most pertinent information about recovery potential, Bogard et al15 suggested 2 versions of a streamlined WMFT (SWMFT) for use with subacute and chronic patients. Data were drawn from 222 participants in the Extremity Constraint Induced Therapy Evaluation trial, and multiple regression methods were conducted to examine the relations between the WMFT-TIME and 3 covariates: functional level, sex, and concordance. Prominent tasks were selected according to whether changes in the patient’s performance were significantly related to overall improvement on the WMFT-TIME. One version was the SWMFT for subacute patients (SWMFT-S), which targeted patients within 3 to 9 months after a stroke. It measured 6 tasks: hand to table, hand to box, reach and retrieve, lift can to mouth, lift pencil from table, and fold towel. The other version was the SWMFT for chronic patients (SWMFT-C), targeting patients 12 months or more after a stroke. It consisted of 4 tasks identical to those in SWMFT-S (hand to box, lift can, lift pencil, and fold towel) and 2 additional tasks of “extend elbow weight” and “turn key in lock.” These tasks reflected improvement in motor function at different stages after a stroke and suggested the necessity of grouping WMFT tasks specific to different chronicity.

Two studies16,17 have empirically examined the psychometric and clinimetric properties of the SWMFTs. One study17 conducted Rasch analysis to investigate construct validity and reliability of the SWMFT-S and SWMFT-C FAS in 2 groups of patients. This study supported the unidimensionality and high reliability (.90) for both versions of the scale. The hand-to-box and hand-to-table tasks in the SWMFT-S scale showed a high correlation of greater than .90, so removal of 1 of these 2 items was recommended. Overall, the SWMFT-S and SWMFT-C were found to be good tools to understand UE motor function in different subgroups of patients after stroke.

Wu et al16 investigated responsiveness and criterion-related validity of the SWMFT-S (TIME scale) in subacute stroke patients with onset of 3 to 9 months. Performance time on individual tasks was used to estimate responsiveness and relationships with criteria measures. They suggested that the responsiveness of the SWMFT-S was comparable to the original performance time scale of the WMFT. The SWMFT-S also demonstrated good concurrent validity and even better predictive validity than the WMFT, and the study concluded that the SWMFT improved clinical utility.

These 2 studies focused on changes and improvement in specific subgroups of stroke patients and examined the use of the SWMFT-S or SWMFT-C in subacute or chronic patient groups, respectively. To date, no studies have examined whether the SWMFT-S or SWMFT-C can be used with patients at 9 to 12 months after a stroke.

Starting at the subacute stage, patients gain improvement in single-joint proximal reaching movements without object grasping, and at later stages, recovery occurs in multiple-joint proximal and distal movements for reaching to grasp functional objects.18-21 However, investigations on individual-onset groups (onsets of 3-9 months and of more than 12 months) and the lack of information on those at 9 to 12 months after a stroke do not provide strong support that the SWMFTs matches theoretical expectations of motor deficit and recovery. Although the original WMFT was consistent with motor theories, the streamlined versions of WMFT might lose important aspects because of removal of items and fail to capture UE long-term recovery after stroke.

The purpose of the current study was to extend previous findings and fill this gap in knowledge about the SWMFT. The study proposed using samples from patients at a broad range of onset after stroke and combining scores on individual SWMFT tasks to examine if the SWMFT-FAS can quantify UE motor recovery from the subacute to chronic stages. In addition, the study examined if the FAS scores of the SWMFTs could be used to detect UE performance of patients at 9 to 12 months after a stroke. The overall aim of this study was to (a) evaluate the construct of the combined SWMFT-FAS and (b) determine which items work better to assess UE motor function in the subgroup of patients at 9 to 12 months after a stroke. Specifically, the study addressed the following questions:

1.

Do SWMFT items work together to measure the continuum of UE motor function from 3 months to years after a stroke?

2.

Do all items function as expected?

3.

Does the sample in the current study provide a wide enough range of UE motor function to evaluate recovery from stroke in patients in stages from subacute to chronic?

4.

Does the item-difficulty hierarchy match clinical knowledge about progress after stroke?

5.

Is the SWMFT-FAS able to evaluate UE motor function from low to high in the 9- to 12-months poststroke group?