Deans' stroke musings: Validation of the Lower Extremity Motor Activity Log (LE-MAL) Questionnaire with Triaxial Accelerometry-Based Activity Monitors in Chronic Post-Stroke Hemiparesis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, April 7, 2026

Validation of the Lower Extremity Motor Activity Log (LE-MAL) Questionnaire with Triaxial Accelerometry-Based Activity Monitors in Chronic Post-Stroke Hemiparesis

This doesn't get anyone recovered, does it? So, you did useless work and your mentors and senior researchers were incompetent in allowing you to continue?

Validation of the Lower Extremity Motor Activity Log (LE-MAL) Questionnaire with Triaxial Accelerometry-Based Activity Monitors in Chronic Post-Stroke Hemiparesis

https://doi.org/10.1016/j.jbmt.2026.03.031 Get rights and content

Under a Creative Commons license

Open access

Abstract

Background

Post-stroke hemiparesis commonly reduces mobility, limiting daily activities and participation. Objective monitoring, such as step counting, quantifies real-world ambulatory activity, while patient-reported outcome measures (PROMs) capture perceived functional performance. The Lower Extremity Motor Activity Log (LE-MAL), translated into Portuguese, assesses self-reported use of the more affected lower limb.

Objective

To examine the criterion-related validity of the LE-MAL by evaluating its association with step counts obtained from triaxial accelerometry activity monitors. Methods: In this cross-sectional validation study, 31 individuals with chronic post-stroke hemiparesis wore activity monitors for at least 10 hours/day over three consecutive days. The LE-MAL was administered via structured interview. Criterion-related validity was assessed using Pearson’s correlation coefficient. Agreement was further explored using the intraclass correlation coefficient (ICC; two-way mixed-effects model, consistency) and Bland–Altman analysis.

Results

The LE-MAL total score showed a positive, moderate correlation with the 3-day average step count (r = 0.52, p < 0.01). Agreement between LE-MAL scores and step counts was low (ICC_single = 0.001, 95% CI −0.35 to 0.35; p = 0.497), consistent with conceptual and metric differences between a PROM and an objective activity count. Bland–Altman analysis indicated a mean bias close to zero, wide 95% limits of agreement, and no evidence of proportional bias.

Conclusion

The LE-MAL demonstrates a positive, moderate association with objectively measured step counts, supporting its criterion-related validity as a PROM of perceived real-world use of the more affected lower limb. Used alongside activity monitoring, it may help clinicians interpret ambulatory behavior in individuals with chronic post-stroke hemiparesis.