Absolutely NOTHING HERE GETS SURVIVORS RECOVERED!
Assessments
are completely worthless unless they point directly to the 100%
recovery protocols. I see nothing here that suggests you go from the
assessment to the chosen 100% recovery protocol. When the hell will the
stroke medical world do ANYTHING TO GET STROKE SOLVED? I'd have you all
fired! A lot of dead wood needs to removed in stroke and until that
occurs stroke will never be solved!
Test-Retest Reliability, Validity, and Sensitivity of the Chedoke Arm and Hand Activity Inventory: A New Measure of Upper-Limb Function for Survivors of Stroke
Susan R. Barreca, Dip PT, BA, Paul W. Stratford, MSc, PT, Cynthia L. Lambert, BSc, PT,
Lisa M. Masters, MSc, OT, David L. Streiner, PhD, C Psych
ABSTRACT. Barreca SR, Stratford PW, Lambert CL, Mas-
ters LM, Streiner DL. Arch Phys Med Rehabil 2005;86:1616-22.
Objectives:
To estimate the test-retest reliability and validity of the Chedoke Arm and Hand Activity Inventory (CAHAI)
and to test whether the CAHAI was more sensitive to change
in upper-limb function than the Impairment Inventory of the
Chedoke-McMaster Stroke Assessment (CMSA) and the Action Research Arm Test (ARAT).
Design:
Construct validation process.
Setting:
Inpatient/outpatient rehabilitation facilities.
Participants:
Stratified sample of 39 survivors of stroke: 24
early (mean age, 71.4y; mean days poststroke, 27.3) and 15
chronic (mean age, 64.0y; mean days poststroke, 101.7).
Intervention: Regular therapy.
Main
Outcome Measures:
Intraclass correlation coefficients (ICCs), receiver operating characteristic (ROC), stan-
dard error of measurement, and correlation coefficients.
Results:
High interrater reliability was established with an
ICC of .98 (95% confidence interval [CI], .96 –.99). The minimal detectable change score was 6.3 CAHAI points. Higher
correlations were obtained between the CAHAI and the ARAT
and CMSA scores compared with the CMSA shoulder pain
scores (1-sided, P=.001). Areas under the ROC curves were as
follows: CAHAI, .95 (95% CI, 0.87–1.00); CMSA, .76 (95%
CI, .61–.92); and ARAT, .88 (95% CI, 0.76 –1.00).
Conclusions:
High interrater reliability and convergent and
discriminant cross-sectional validity were established for the
CAHAI. The CAHAI is more sensitive to clinically important
change than the ARAT.
Key Words: Arm; Cerebrovascular accident; Hand; Outcome assessment (health care); Recovery of function; Rehabilitation.
© 2005 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and
Rehabilitation
DESPITE IMPROVEMENTS IN THEIR general physical
mobility,
1
many survivors of stroke continue to experience
great difficulty in regaining functional use of their affected
arms and hands.
2-5
Although impairment measures, generic
health status measures, and client satisfaction surveys may be
used to evaluate upper-limb recovery,
6
functional assessments
are considered key in evaluating therapy aimed at improving
how survivors of stroke use the paretic upper limb in their daily
lives.
7,8
Validating a scale is a process whereby one determines the
degree of confidence one can have in inferences made about
people based on their scores from that scale.
9
An important
aspect of validity is a measure’s ability to detect the magnitude
of change over time in a person or a group. It is this latter type
of measure that is required to evaluate arm and hand functional
recovery in survivors of stroke and the effectiveness of therapeutic intervention programs designed to foster this recovery.
One of the most commonly used upper-limb assessments
2
is
the Action Research Arm Test (ARAT),
10
a shortened version
of the Carroll test that was developed in 1965.
11
This measure,
which consists of 19 movements that are grouped into 4
subtests, was never explicitly developed for the stroke population.
10
Four of the items are impairment-oriented items (eg,
touch top of head, hand behind head), and the remaining items
are contrived functional items (eg, pick up ball bearings of
various sizes between the thumb and each digit). In studies that
used the ARAT to assess poststroke upper-limb function, a
floor effect has often been observed.
2
Finally, none of the
existing scales, including the ARAT, take account of patients’
preferences for upper-limb tasks.
Conversely, the Chedoke Arm and Hand Activity Inventory
(CAHAI) was methodically developed to include relevant
functional tasks (appendix 1), meet the World Health Organization’s definition of activity,
12
and be sensitive to clinically
important changes in upper-limb function. Face, content, and
factorial validity of the CAHAI have been reported else-
where.
13
In brief, 751 items were generated from survivors of
stroke, their caregivers, and the literature.
13
Twenty-six potential tasks were administered to 145 survivors of stroke participating in active rehabilitation to assess the frequency endorsement, factorial loading, and administration feasibility of those
items.
13
A balance between statistical analyses and clinical
judgment was used to select the final items.
The CAHAI consists of 13 real-life functional tasks that
reflect (1) the domains deemed important by survivors of
stroke; (2) bilateral activities; (3) non– gender-specific items;
(4) the full range of normative movements, pinches, and
grasps; and (5) the various stages of motor recovery poststroke.
Accompanied by a detailed instruction manual, the CAHAI
may be completed in approximately 25 minutes. Because the
internal consistency (.98) of the measure and the single-item
factor loadings (range, .76 –.96) are high, the CAHAI appears to be assessing a single construct—that is, upper-limb func-
tion.
14
The primary purpose of this study was to estimate test-retest
reliability, validity, and sensitivity to change of the CAHAI. A
secondary purpose was to test whether the CAHAI was more
adept than the impairment inventory of the Chedoke-McMaster
Stroke Assessment (CMSA)
15,16
and the ARAT
10
at distinguishing change in survivors of stroke who had an acute onset
with mild to moderate motor impairments (where we expect to
see considerable change) from that in people who had chronic,
severe motor impairments (where we expect to see no change).
The ultimate goal when assessing sensitivity to change is to
distinguish among patients whose health status has improved,
deteriorated, or remained stable.
17
Our hypotheses were as
follows: In the null hypothesis, there would be no differences
in the abilities of the CAHAI, CMSA, and the ARAT to
distinguish change in patients with acute onset of stroke and
mild to moderate motor impairments from change in patients
with chronic presentation. For the alternative hypothesis, the
CAHAI would be more adept than the CMSA and the ARAT
in distinguishing change (1-sided, P.05) in patients with
acute onset and mild to moderate motor impairments than in
patients with chronic, severe deficits.
More at link.
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