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

 

Assessments like this that don't lead to EXACT RECOVERY PROTOCOLS are COMPLETELY FUCKING USELESS!

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. 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. 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; Out- come assessment (health care); Recovery of function; Rehabilitation. © 2005 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

D ESPITE 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 Organi- zation’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 partic ipating in active rehabilitation to assess the frequency endorse- ment, 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 

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