Abstract
Objectives.
To derive a shorter version of the Motor Activity Log
Quality-of-Movement Scale (MAL-28) with enhanced content and construct
validity.
Design. Validation cohort.
Setting. Outpatient rehabilitation within an academic laboratory.
Participants.
Retrospective consecutive sample of 149 community-dwelling adults with
chronic mild/moderate upper-extremity hemiparesis caused by stroke or
multiple sclerosis (MS). Intervention. Not applicable.
Methods.
Participants received the MAL-28 at baseline and following
upper-extremity rehabilitation. Rasch Measurement Theory informed
threshold ordering of scoring categories, tests of fit, differential
item functioning, targeting, response dependency, local dependency, and
reliability (person separation index [PSI]). Seasoned examiners rated
the content validity of each item. Test-retest reliability of the
revised scale was calculated.
Results. We established content and construct validity for 18 items. The resultant 18-item MAL fit the model (χ2 = 77.93; df = 72; P
= .30) and targeted the population—that is, minimal floor (12.08%) or
ceiling effects (0%), with acceptable reliability (PSI = 0.84) and good
test-retest reliability [ICC(1, 1) = 0.86]. The hierarchy of item
difficulty was independent of sex, age, affected side, diagnosis, or
intervention type used, and there was local dependency in 3 pairs of
items. Responses from a subsequent testing session were dependent on the
responses from prior testing, indicating response dependency, for which
a correction was proposed. Once response dependency was neutralized,
there was a 15% greater treatment response.
Conclusions. Content
and construct validity are established for Rasch-based MAL-18 for
chronic stages of stroke and MS. A Rasch-based conversion table enables
clinical use of the MAL-18.
, Lynne Gauthier, PhD
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