The Adult Assisting Hand Assessment Stroke: Psychometric properties of an observation-based bimanual upper-limb performance measurement

I see zero use for assessments. Why not deliver EXACT STROKE PROTOCOLS THAT DELIVER 100% RECOVERY,  instead of this lazy shit. Inter-rater reliability does nothing for survivor recovery!

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day. 

(Where is the creation of protocols that deliver recovery? Without that this research is useless!)
The Adult Assisting Hand Assessment Stroke: Psychometric properties of an observation-based bimanual upper-limb performance measurement

Van Gils A, Meyer S, Van Dijk M, Thijs L, Michielsen M, Lafosse C, Truyens V, Oostra

K, Peeters, A, Thijs V, Feys H, Krumlinde-Sundholm L, Kos D , Verheyden G

Abstract

Objective: To investigate interrater and intrarater reliability, measurement error and convergent

and discriminative validity of the Adult Assisting Hand Assessment Stroke (Ad-AHA Stroke).

Design: Cross-sectional observational study

Setting: Seven stroke rehabilitation centers

Participants: A total of 118 stroke survivors (reliability sample: n=30; validity sample: n=118) were

included (median age 67 years (interquartile range (IQR) 59-76); median time post stroke 81 days

(IQR 57-117).

Main Outcome Measures: Ad-AHA Stroke, Action Research Arm Test (ARAT), Upper Extremity

Fugl-Meyer Assessment (UE-FMA). The Ad-AHA Stroke is an observation-based instrument

assessing the effectiveness of the spontaneous use of the affected hand when performing bimanual

activities in adults after stroke. Reliability of Ad-AHA stroke was examined using intraclass

correlation coefficients (ICC), Bland-Altman plots, and weighted kappa (Kw) statistics for reliability

on item level. Standard error of measurement (SEM) was calculated based on Ad-AHA units.

Convergent validity was assessed by calculating Spearman rank correlation coefficients between

Ad-AHA stroke and ARAT and UE-FMA. Comparison of Ad-AHA stroke scores between subgroups

of patients according to hand dominance, neglect and age evaluated discriminative validity.

Results: Intrarater and interrater agreement showed an ICC of 0.99 (95% CI=0.99-0.99), a SEM of

2.15 and 1.64 out of 100, respectively and Kw for item scores were all above 0.79. The relation

between Ad-AHA and other clinical assessments was strong (ρ=0.9). Patients with neglect had

significantly lower Ad-AHA scores compared to patients without neglect (ρ=0.004).

Conclusion: The Ad-AHA Stroke captures actual bimanual performance. Thereby it provides an

additional aspect of upper limb assessment with good to excellent reliability and low SEM for

patients with sub-acute stroke. High convergent validity with ARAT and UE-FMA and discriminative

validity was supported.