Responsiveness and construct validity of two outcome measures of bilateral upper limb function in patients with chronic stroke

 'Measurements' DO NOTHING FOR RECOVERY! You need EXACT REHAB PROTOCOLS FOR THAT, and you completely fucking failed at creating them! YOU'RE FIRED!

Responsiveness and construct validity of two outcome measures of bilateral upper limb function in patients with chronic stroke

 Han-ting Tsai^1,2† Hiu-ying Lau^2† Keh-chung Lin^2,3* Yi-chun Li⁴ Chia-jung Lin² Grace Yao⁵ Ya-yun Lee⁶ Wen-shiang Chen⁷ Chia-ling Chen^8,9 Ya-ju Chang^10,11,12 Yi-shiung Horng^13,14

 1 Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 

2 School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan 

3 Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan 

4 Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung, Taiwan 

5 Department of Psychology, National Taiwan University, Taipei, Taiwan 

6 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan 

7 Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 

8 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan 

9 Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan 

10 Neuroscience Research Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan 

11 School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan 

12 Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan 

13 School of Medicine, Tzu Chi University, Hualien, Taiwan 

14 Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan

Background: Stroke is a leading cause of long-term disability among stroke survivors. Despite the availability of numerous stroke rehabilitative therapies, such as mirror therapy, bilateral arm training, and robot-assisted therapy, the recovery of motor function after stroke remains incomplete. Bilateral arm function is a key component in stroke patients to perform activities of daily living and to reflect their functional autonomy.

Objective: This clinimetric study investigated and compared the construct validity and responsiveness of 2 bimanual activity outcome measures, the Chedoke Arm and Hand Activity Inventory (CAHAI) and the ABILHAND Questionnaire, in individuals receiving stroke rehabilitation.

Methods: The present study is a secondary analysis following the framework of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Individuals with chronic stroke (N = 113) were recruited from outpatient rehabilitation settings. Participants received 18 to 20 sessions of robot-assisted therapy, mirror therapy, combined therapy, or conventional rehabilitation for 4 to 6 weeks. The CAHAI, ABILHAND Questionnaire, and a comparison instrument, the Motor Activity Log (MAL), were administered twice at a 4- to 6-week interval to all participants. ABILHAND scores, in logits, were converted from raw ordinal scores into a linear measure.

Results: There was medium to large correlation of the CAHAI and the MAL (ρ = 0.60–0.62, p < 0.01) as well as the ABILHAND Questionnaire and the MAL (ρ = 0.44–0.51, p < 0.01). Change scores from the initial measurement to the post-intervention measurement demonstrated small to medium correlation of the CAHAI and the MAL (ρ = 0.27–0.31, p < 0.01) and medium to large correlation of the ABILHAND Questionnaire and the MAL (ρ = 0.37–0.41, p < 0.01). Overall, 7 of 8 hypotheses were supported. The hypothesis testing regarding the construct validity and responsiveness of the CAHAI and ABILHAND Questionnaire was confirmed.

Conclusion: The CAHAI and ABILHAND Questionnaire are both responsive and suitable to detect changes in bilateral arm functional daily activities in individuals with chronic stroke. Patient-reported outcome measures are recommended to use along with therapist-rated outcome measures for upper limb capacity evaluation in stroke rehabilitation. Further study with a prospective study design to capture specific clinical features of participants and the use of body-worn sensors, such as the arm accelerometer, is suggested.