Action Research Arm Test

Chronic and Acute Stroke, Multiple Sclerosis & Traumatic Brain Injury: (Platz et al., 2005; n = 23)

Chronic and Acute Stroke, Multiple Sclerosis & Traumatic Brain Injury: (Platz et al., 2005; n = 44)

Chronic and Acute Stroke, Multiple Sclerosis & Traumatic Brain Injury: (Platz et al., 2005; n = 56; mean age = 54, range = 13-92 years)

The above table indicate the ARAT's is strongly related to the:

• Fugl-Meyer motor

• Box and Block Test

• Motricity Index

Negatively related to the Ashworth Scale, moderately related to the Fugl-Meyer sensation and joint motion/pain scales and Not related to the Modified Barthel Index

The ARAT is a modified version of the Upper Extremity Function Test (UEFT)

(Simpson, 2013) A literature review identifying responsiveness data in patients post stroke (van der Lee, 2004 and Hsueh, 2002).

• 1.3

• Note: effect size for perceived effect ( e.g. MAL) were 1.66.2 times larger than the functional changes (measured ARAT or Wolf)

Stroke:

(Simpson, 2013)

• MDC₉₀ = 3.0

• MDC₉₅ = 3.5

Chronic Stroke: (van der Lee et al., 2001; n = 20; mean age = 62 (IQR = 52.5–71.8) years; median time since stroke = 3.6 years; mean ARAT score = 29.2 points)

• MCID = 10% of the measures total range (i.e. 5.7 points)

Chronic Stroke: (van der Lee et al., 2001; n = 22, mean age = 58.5 years; mean time since stroke = 3.6 years; Median baseline ARAT score = 38.0 points)

• MCID = 5.7

Acute Stroke: (Lang et al., 2008; mean age = 64 (14); time between stroke and first assessment = 9.5 (4.5) days)

MCID=12-17 points

Chronic Stroke: (van der Lee et al., 2001)

• Mean (SD) intake ARAT score 29.2 (12.5)
• Mean (SD) intake Fugl-Meyer Assessment score 49.2 (9.9)

Item norms (based on healthy elderly adults): 

Time limits (mean + 2 SD of the performance times of 20 healthy elderly subjects)
If performance is slower than the time limit or if the patient loses contact with the back of the chair during performance, the score is 2 instead of 3.

Acute Stroke: (Beebe and Lang, 2009; mean age = 56.9 (10.2), times since stroke onset = 18.6 (5.6) days)

Acute Stroke: (Nijland et al., 2010; n = 40; mean age = 60 (13.6) years; median ARAT score = 38; times since stroke onset < 6 months; Dutch sample)

• Excellent interrater reliability (ICC = 0.92)

Chronic Stroke: (Van der Lee et al., 2001)

• Excellent Interrater Reliability (ICC = 0.995)
• Excellent Intrarater Reliability (ICC = 0.989)

Chronic Stroke: (Yozbatrin et al., 2008)

Interrater Reliability

Intrarater Reliability

(Page, 2015) Patients an average of 4.6 years since stroke with moderate upper extremity paresis

• Excellent Intrarater reliability (ICC = 0.99, 95% CI 0.98-0.99)

(Page, 2012) Patients greater than 12 months post-stroke with minimal upper extremity paresis enrolled in trial. Measurements were made before starting the trial, approximately 1 week apart.

• Adequate Intrarater reliability (ICC = 0.71, 95% CI 0.53-0.89)

Acute Stroke: (Nijland et al, 2010)

• Excellent Internal Consistency (Cronbach's alpha = 0.985)

Chronic Stroke: (van der Lee et al., 2001)

• Evidence of concurrent validity confirmed by comparison with the upper limb subtest of the Fugl- Meyer Assessment and the Motor Assessment Scale.

Chronic Stroke: (Yozbatiran et al., 2008)

• Excellent correlation between ARAT and arm motor score of the Fugl-Meyer (r = 0.94, p<0.01)

(Chen, 2012) Patients seen an average of 17.19 (±15.29) months post-stroke

• Adequate predictive validity with the composite physical domain and hand domain of the Stroke Impact Scale (ρ = 0.45 and 0.58, p<0.001, respectively)

• Excellent predictive validity with the performance time and functional ability scale on the Wolf Motor Function Test (ρ = -0.66 and 0.76, p<0.001, respectively), Motor Activity Log Amount of Use (30) and Quality of Movement (30) (ρ = 0.62 and 0.66, p<0.001, respectively)

(Page, 2015) Patients an average of 4.6 years since stroke with moderate upper extremity paresis

• Excellent concurrent validity with the Wrist Stability and Hand Mobility Subscales of the Fugl-Meyer Assessment (0.67-0.74, p < .001)

(O’Dell, 2014) Community-dwelling volunteers seen an average (mean (SD)) of 4.1 (4.5) years post-stroke for upper extremity robotics training

• Excellent concurrent validity ( 0.79, p = 0.001) with the 9-item version of the Arm Motor Ability Test.

(Wei, 2011) Twenty-seven stroke participants with moderate motor impairment in their affected upper extremity, an average of 4.92 ±0.45 years post-stroke.

• Excellent concurrent validity (0.81 – 0.96, p < 0.01) with the Fugl-Meyer Assessment and Motor Status Scale.

(Lin, 2010) Fifty-nine stroke participants an average of 16.14 ± 13.95 months post-stroke engaging in upper extremity training or placebo.

• Adequate concurrent validity (0.31 – 0.54, p < 0.05) with the Fugl-Meyer Assessment, Motor Activity Log-Amount of Use and Quality of Life, and Stroke Impact Scale Hand Function Domain.

(Chuang, 2012) Sixty-seven participants an average of 21.12 ± 13.63 months post-stroke had functional state of upper extremity skeletal muscle assessed with a Myoton-3 myometer to measure tone, elasticity and stiffness.

Pretreatment

• Poor concurrent validity of the ARAT with muscle tone, elasticity and stiffness of the flexor carpi radialis (0.27, [p < 0.05], 0.02 [P>0.06], and 0.30 [p<0.05])

• Poor concurrent validity with the ARAT and muscle tone, elasticity and stiffness of the extensor digitorum (-0.01 to -0.03) and the flexor carpi radialis (-0.07 to 0.10).

Posttreatment

• Poor to Adequate concurrent validity of the ARAT with muscle tone, elasticity and stiffness of the flexor carpi radialis (0.29 [P<0.05], 0.03 [P>0.05) and 0.36,[ < 0.01])

• Poor concurrent validity with the ARAT and the muscle tone, elasticity and stiffness of the extensor digitorum(-0.-8 to 0.19) and the flexor carpi ulnaris (-0.18 to 0.11)

(Edwards, 2012) Fifty-one post-stroke subjects as part of the VECTORS (constraint induced movement therapy) study assessed at Day 0 (9.5 ± 4.5), Day 14 (24.9 ± 10.6), Day 90 (110.8 ± 20.7).

• Adequate to Excellent concurrent validity with the Wolf Motor Function Test, Functional Ability Score (WMFT FA)

(Lee, J., 2015) Fifteen subjects an average of 3.1 ± 2.3 years post-stroke who wore accelerometers while completing the ARAT

• Poor concurrent validity (0.24) on the affected side, and Excellent concurrent validity on the non-affected side (0.91).

(Lee, G., 2015) Forty-three participants were recruited a mean 15.21 ± 3.32 months post-stroke for assessment.

• An Adequate negative correlation was found (-0.41;p<0.05) with hypertonia (defined as a Modified Ashworth Scale Score of > 1+)

• Adequate predictive validity (Cut-off ≤ 15.50/57 points, AUC .76 (95% CI 0.61-0.90, p <0.01). If a person had an ARAT score of ≤ 15.50/57 points, they had a 1.359 increased risk of having a Modified Ashworth Scale score of ≥ 1+ (p = 0.051, 95% CI 1.01-1.82)

(Li et al, 2015) A study with 95 individuals with first time stroke greater than one month post, < 2 on the Modified Ashworth and good mental status (MMST >24) reported significant and adequate concurrent and predictive correlations between arm kinematics (movement time) and the ARAT during reaching (with and without trunk constraint) .

(Page, 2012) Patients greater than 12 months post-stroke with minimal upper extremity paresis enrolled in trial.

• Excellent concurrent validy with the Wrist/Hand Subscales of the Fugl-Meyer Assessment.

(Hsieh, 2009) A cohort of 57 stroke participants (an average of 12.98±7.62 months post-stroke) with assessments completed prior to and after treatment in an effectiveness trial examining distributed constraint-induced therapy and bilateral arm training.

• Poor predictive validity (Spearman ρ (95% CI)) between the ARAT and the Functional Independence Measure-Total Score (0.22 (-0.04, 0.46, not significant)) and the Functional Independence Measure-Motor Score (0.26 (0.00, 0.49, not significant)).

(Awert et al (2015) 50 patients post first stroke ( < 5 years), participating in outpatient rehabilitation, capable of completing a self assessment questionnaire Michigan Hand Outcomes Questionnaire (MHOQ) and strength testing (ARAT) .

• Excellent correlations between the MHOQ and the ARAT for all patients (0.64; p<0.001) and for patients with arm impairments (0.60; P<0.000).

(Houwink, 2011) Twenty-one participants admitted to rehabilitation, with a stroke diagnosis occurring less than six weeks prior to admission.

• Excellent cross-sectional (0.91, p < 0.001) and longitudinal, 3 months in between assessments, (0.71, p < 0.001) correlations with the Stroke Upper Limb Capacity Scale.

(Rabadi and Rabadi 2006) A study of 104 patients in an acute stroke rehabilitation (16±9 days on average post stroke) measured the performance on the ARAT within 72 hours of admission and 24 hours before discharge as well as the FMA National Institutes of Health Stroke Scale, FIM instrumental total score and FIM activities of daily living.

• The Spearman rank correlation of ARAT was excellent with the FMA (rho=0.77 on admission and 0.87 on discharge, P<0.001), adequate with the FIM-ADL on admission and discharge (0.32; P<0.001) and adequate to poor for the FIM (0.33 admission and 0.21 discharge; P<0.001)

(Hsieh, 2009)

• Excellent construct validity at pre-treatment and post-treatment was found between the ARAT and the Fugl-Meyer Assessment (0.73-0.74, p<0.01) and the Wolf Motor Function Test-Functional Ability Scale (0.68-0.77, p<0.01).

• Adequate to Excellent construct validity was found between the ARAT and the Wolf Motor Function Test-Performance Time (0.58-0.63, p<0.01).

• Poor construct validity was found between the ARAT and the Functional Independence Measure-Motor Score (0.27-0.39, p<0.01).

The ARAT is a modified version of the Upper Extremity Function Test (UEFT)

Acute Stroke: (Lin et al., 2009; n = 53; mean age = 64; Taiwanese sample)

Acute Stroke: (Nijland et al., 2010)

• Floor effects for scores < 3
• Ceiling effects for scores > 54

(Edwards, 2012)

(Hsueh, 2002) Forty-eight participants undergoing rehabilitation. At admission it was a median of 24 days (range 7-53) post-stroke.

Chronic Stroke: (van der Lee et al., 2002; n = 31 (RIQ = 52–66) years; mean baseline ARAT score = 30.27; > 1 year post stroke)

• 1.2 points (using Lyle’s decision rule) 
• 1.7 points (summing items)

Acute Stroke: (Lin et al., 2009; n = 53; mean age = 64; Taiwanese sample)

Acute Stroke: (Beebe and Lang, 2009)

Acute Stroke (Lang et al., 2006; mean age = 64 (14), Admission NIHSS = 5.3 (1.8); time between stroke and first assessment = 9.5 (4.5) days)Acute Stroke: (Beebe and Lang, 2009)

(Edwards, 2012)

(Tong and Hu, 2011) Twenty seven patients chronic post stroke (avg.4.92 years) with low level arm function participated in a robotic training paradigm and responsiveness was measured with the FMA, MSS and ARAT using the standardized response mean (SRM) and the Guyatt’s Responsiveness Index (GRI).

• There were no significant gains in the scores on the ARAT after treatment (25.00 [11.25] to 25.86 [10.82])

• The responsiveness was low with SRM 0.22 and GRI 0.81

• The responsiveness was lower for the ARAT than the FMA and MSS. In addition, the responsiveness was lower than 0.85 reported in a previous Hseih study (2009) The ARAT may not be as responsive in patients with greater upper limb impairments (e.g. baseline ARAT score for the Hseih study was 42.72 + 12.11 compared to the Wei study with a baseline score of 23.48 + 11.62).

(Rabadi and Rabadi 2006)

• The SRM was 0.68 (admission score of 23 ±24 and discharge score 36±23

• This SRM was lower than reported by vanderLee and Roord (2002) which included subjects with a higher level of upper limb function (ARAT score 30.27 at baseline with subjects > 1 year post stroke)

(Hsieh, 2009)

• The standardized response mean (95% CI) of the ARAT was found to be 0.95 (0.75, 1.20, Wilcoxon Z = 4.64, p<0.01).

• The ARAT had a smaller standardized response mean (difference in SRM (95%CI) when compared against the Fugl-Meyer Assessment (0.47 (0.09, 0.89, p<0.05)) and the Wolf-Motor Function Test-Functional Ability Scale (0.35 (-0.01, 0.78, p = not significant)). However, the ARAT had a greater standardized response mean when compared to the Wolf-Motor Function Test-Performance Time (0.57 (0.28, 0.86, p<0.05)).

(Lin, 2010)

• The standardized response mean (95% CI) was found to be 0.79 (0.63-1.10, Wilcoxon Z = 5.76, p<0.001).