Motricity Index

Chronic Stroke: (Fayazi, Dehkord, Dadgoo, & Salehi, 2012; n = 20; age range = 37 to 76; time post stroke range = 3 months to 4 years; male = 10; female = 10)

• SEM for entire group (n = 20): 4.66

Chronic Stroke: calculated using SEM from (Fayazi et al., 2012)

• MDC: 12.92

MCID is not reported in the literature.

Upper Extremity Hemiparesis: (Sunderland, Tinson, Bradley, & Hewer, 1989; n = 38; age range = 31 to 82; average age = 67; left arm affected, n = 21; right arm affected = 17; MCA stroke, n = 36; brainstem stroke, n = 2)

• 1 month cut-off scores > 18 indicates a score above zero on Frenchay Arm Test at 6 months, measuring functional use of affected limb

Acute/Chronic Stroke: (Demeurisse, Demol, & Robaye, 1980; n = 100; measured at 11 days, 2, 4 and 6 months post stroke; mean age (total) = 69, 59 men, mean age = 67; 41 women, mean age = 71; left side hemiplegia = 36, right side hemiplegia = 64)

*Authors do not report the normative data, but the measure and subsequent norms were developed using this population

Subacute/Chronic Stroke: (Collin & Wade, 1990; n = 36; weeks post stroke = 6 (27 weeks), 12 (25 weeks); 18 (14 weeks); age range (male) = 15 to 77; mean age (male) = 56.1; age range (female) = 45-69; mean age (female) = 59.9; right side hemiplegia = 21)

• Observer 1 upper extremity (SD): 30 (36)
• Observer 2 upper extremity (SD): 31 (39)

Mean

Standard Deviation

Observer 1

30

36

Observer 2

31

39

Acute/Subacute Stroke: (Bohannon, 1999; n = 15; age range = 46 to 81; mean age = 66.7; within 15 days of onset; no comorbidities affecting upper extremity)

• Pinch-grasp mean, median, range score: 15.2; 20.5; 0-33.0
• Elbow flexion mean, median, range score: 19.7; 25.0; 0-33.0
• Shoulder abduction mean, median, range score: 18.7; 22.0; 0-33.0
• Total motricity mean, median, range score: 54.6; 70.5; 1-100.0

Motricity Index Subscale

Mean (95% CI)

Median

Range

Pinch-Grasp

15.2 (5.5-24.9)

20.5

0-33.0

Elbow Flexion

19.7 (10.3-29.1)

25.0

0-33.0

Shoulder Abduction

18.7 (10.6-26.8)

22.0

0-33.0

Total Motricity

54.6 (28.2-81.0)

70.5

1-100.0

Acute/Chronic Stroke: (Hsieh et al., 1998; n = 50; mean age = 65; male = 30; female = 20; median, range days post onset = 55 (8-535); subarachnoid hemorrhage = 7; cerebral hemorrhage = 13; cerebral infarction = 21; other = 9; right-sided paresis = 22; left-sided paresis = 23; bilateral paresis = 5)

• Mean score for total upper extremity motricity: 46.2 (31.9)

Subacute/Chronic Stroke: (Jacob-Lloyd, Dunn, Brain, & Lamb, 2005; upper extremity n = 22; age > 60 years, n = 85%(of total study n = 55); assessed average of 76 days post onset and 6 months + 76 days (average) post onset)

• Discharge (average 76 days post onset) median: 77
• Discharge (average 76 days post onset) IQR: 77-84
• 6 month post discharge median: 100
• 6 month post discharge IQR: 77-100

Time Post Onset

Median

IQR

Discharge (76 day average)

77

77-84

6 months post discharge

100

77-100

Lower Extremity:

Subacute/Chronic Stroke: (Collin & Wade, 1990)

• Observer 1 lower extremity (SD): 52 (20)
• Observer 2 lower extremity (SD): 55 (22)

Median

Standard Deviation

Observer 1

52

20

Observer 2

55

22

Subacute/Chronic Stroke: (Jacob-Lloyd et al., 2005)

• Discharge (average 76 days post onset) median: 76
• Discharge (average 76 days post onset) IQR: 52-94
• 6 month post discharge median: 76
• 6 month post discharge IQR: 48-100

Time post onset

Median

IQR

Discharge (76 day average)

76

52-94

6 months post discharge

76

48-100

Subacute Stroke: (Cameron & Bohannon, 1999; n = 15; age range = 29 to 77; mean age = 53.7; male = 11; female = 4; left-sided hemiparesis = 8; right-sided hemiparesis = 7)

• Hip flexion mean: 20.3
• Hip flexion standard deviation: 6.5
• Hip flexion range: 9-33
• Knee extension mean: 21.2
• Knee extension standard deviation: 7.7
• Knee extension range: 0-33
• Ankle dorsiflexion mean: 11.7
• Ankle dorsiflexion standard deviation: 10.6
• Ankle dorsiflexion range: 0-33
• All mean: 54.3
• All standard deviation: 20.9
• All range: 10-100

Motricity Index Subscale

Mean

Standard deviation

Range

Hip flexion

20.3

6.5

9-33

Knee extension

21.2

7.7

0-33

Ankle dorsiflexion

11.7

10.6

0-33

All

54.3

20.9

10-100

Chronic: (Fayazi et al., 2012)

• Mean score at week 1 (SD): 58.20 (17.683)
• Mean score at week 2 (SD): 56.60 (19.632)

Week 1

Week 2

Mean score (SD)

58.20 (17.683)

56.60 (19.632)

Chronic Stroke: (Fayazi et al., 2012)

• Excellent test-retest reliability: (ICC = .93)

Subacute/Chronic Stroke: (Collin & Wade, 1990)

• Excellent interrater reliability: MI arm (Spearman’s rho = .88, p < 0.001)
• Excellent interrater reliability: MI leg (Spearman’s rho = .87, p < 0.001)
• Excellent interrater reliability: MI side (Spearman’s rho = .88, p < 0.001)

Chronic Stroke: (Fayazi et al., 2012)

• Excellent intra-rater reliability (ICC = 0.93, 95% CI = 0.84-0.97, p < 0.001)

Normative Sample: (Haley et al., 1992; n = 412)

• Excellent: Cronbach's alpha = .95-.99*

*Scores > .9 may indicate redundancy in scale questions.

Acute Stroke: (Cameron & Bohannon, 2000; n = 15)

• Adequate: Cronbach α of lower extremity = .77
• Upper extremity = unknown

Predictive validity

Subacute/Chronic Stroke: (Collin and Wade, 1990)

• Excellent predictive validity of MI score at 6 weeks and walking ability at 18 weeks

Upper Extremity Hemiparesis: (Sunderland et al., 1989)

• Cut off scores on Motricity Index at 1 month were best predictor of functional outcomes at 6 months when compared with percentage grip, the Motor Club Assessment, Frenchay Arm Test, and the 9-Hole Peg Test (Sunderland et al., 1989)

Subacute/Chronic Stroke: (Collin & Wade, 1980)

• At 6 weeks post stroke, lower scores on the MI-Leg combined with the Trunk Control Test predicted failure to walk by 18 weeks.

One Year or More Post Stroke: (Kong et al., 2011; n = 140; mean age = 61.0 (13.3); male, n = 88; UE MI mean = 21.0 (25.9); LE MI mean = 29.8 (27.2); Modified Barthel Index mean = 42.8 (26.3); Dysphasia, n = 37; Neglect, n = 32; Sensory impairment, n = 80)

• Only 28.3% gained upper limb dexterity post stroke
• Sensory impairment, severe spasticity and low scores on MAS, UEMI and LEMI were significantly correlated to poor dexterous function
• Severe spasticity was correlated with low UEMI score and poor dexterity
• Poor dexterous function was predicted by a severe stroke, neglect, sensory impairment, total/partial anterior circulation stroke and low MBI, UEMI and LEMI scores on rehabilitation admission
• The most important predictor of dexterity was the UEMI score on admission to rehabilitation
• The ability to do a pin grip at admission to acute rehabilitation was a predictor of recovering UE dexterity ( e.g. the probability of regaining dexterity was 3.4% in patients with absent pinch group but 80% in those with MI scores of 22 or higher)

Factors correlating MI scores to Upper Limb Dexterity

Variable

Upper Limb

Dexterity

Yes No

P Value

Upper Extremity MI score (Rehab)

Lower Extremity

MI score (Rehab)

48.7

(20.7)

11.2

(19.1)

55.0

(17.6)

19.8

(23.7)

<0.001

<0.001

Stroke: (Bland et al., 2012; two samples of patients in an inpatient rehabilitation facility unit (n = 110 and 159; mean age 62 (14) and 63 (15), respectively)

• Admission Lower extremity MI was 65 (26) and 59 (30), respectively in patients subacute post stroke
• Adequate correlation between Lower Extremity MI at admission and speed of 10-meter walk speed at discharge (r = 0.47)
• The lower extremity MI did not explain a significant amount of the variance in walking speed at discharge nor differentiate household versus community.

Ischemic or Hemorrhagic Stroke: (Aufman et al., 2013; n = 198; mean age of nondrivers = 64.1 (± 14.0); mean age of nonreturners = 59.9 (±13); mean age of returners = 61.5 (± 13.7))

• LEMI and FIM-C explained 30% of the variance in patients who returned to driving at six months post-stroke.

Acute Stroke: (Cameron & Bohannon, 2000)

• Excellent predictive validity of dynamometer measurements and MI arm scores (r = 0.78)
• Excellent predictive validity of dynamometer measurements and MI leg scores (r = 0.91)

Concurrent validity

Stroke: (Arwert et al, 2016; n = 51; average time since stroke = 8 months (3-27 months); female, n = 16)

• Excellent concurrent validity between the MHQ and the Arm MI for all patients (r = 0.78)
• Average concurrent validity between the MHQ and the Arm MI for patients with less than 100 on the Arm MI (r = 0.65)
• Average to Excellent concurrent validity between Arm MI and functional subscales of the MHQ

Subscales of the MHQ

MI correlation

Overall Hand Function

0.80

ADL

0.67

Pain

0.43

Work Performance

0.59

Aesthetics

0.67

Satisfaction

0.72

MHQ Total

0.78

Upper Extremity: (Sunderland et al., 1989)

• When comparing the 9 Hole Peg Test, Motor Club Impairment, Frenchay Arm Test and MI Arm Score, the MI Arm test was the most sensitive measure in detecting early change

Stroke: (Bohannon, 1999)

• Excellent concurrent validity between dynamometry measurements of the upper extremity and the MI Arm Score (r = 0.89; p<0.001)

Acute Stroke: (Cameron & Bohannon , 2000), (Bohannon, 1999), (Sunderland et al., 1989)

• Excellent concurrent validity between dynamometry measurements and Leg MI
  • Hip Flexion (r = .85)
  • Knee Extension (r = .83)
  • Ankle Dorsiflexion (r = .89)
  • All (r = .78)
• Excellent concurrent validity between dynamometry measurements and Arm MI
  • MI Pinch Grasp and Dynamometry Hand Grasp (r = .81)
  • Elbow Flexion (r = .87)
  • Shoulder Abduction (r = .80)
  • All (r = 0.91)

Subacute/Chronic Stroke: (Collin & Wade, 1990)

• Excellent concurrent validity between the Rivermead Motor Assessment and the MI

Time

RMA/MI-arm

RMA/MI-leg

6 weeks

0.76*

0.81*

12 weeks

0.73*

0.81*

18 weeks

0.74**

0.75**

* p < 0.001; ** p < 0.01

Post Stroke Hemiplegia: (Lu et al., 2015; n = 22; mean age = 54.8 (8.5); male, n = 18; able to walk independently; mean Leg MI score = 70.4 (21.5); Chinese sample)

• Adequate concurrent validity of the Wisconsin Gait Scale (WGS) with the MI (r = -0.687; p < 0.01)
• Excellent concurrent validity of the Gait Abnormality Rating Scale (GARS) with the MI (r = -0.742; p < 0.01)

Within 6 Months Post Stroke: (Meyer et al., 2015; n = 122; males, n = 77; mean post stroke time = 82 days; average age = 67 (58.8-76.1; Belgian sample)

• Upper limb somatosensory impairments were common, with prevalence rates 21%- 54%
• Poor to Adequate concurrent validity between somatosensory deficits and MI scores for the UE (r =  -0.56 to 0.35)
• Poor to Adequate concurrent validity between somatosensory and motor deficits (r = 0.22-0.61)
• There were consistently stronger correlations between motor and somatosensory deficits in patients with visuospatial neglect ( r = 0.44-0.78) compared to patients without neglect (r = 0.08-0.59)
• The MI median (interquartile range) was 67.5 for patients overall and 23 (0-83) for those with Neglect and 76 for patients without neglect (p < 0.02)

Somatosensation

Association with MI

Exteroceptive

Em-NSA light touch

Em-NSA pressure

Em NSA pinprick

PTT light touch

Proprioceptive

Em-NSA movement sense

TFT position sense

Higher Cortical

Em-NSA sharp/dull

NSA stereognosis

Two point discrimination

0.318

0.337

0.348

-0.564

0.394

-0.354

0.220

0.535

-0.316

Em-NSA = Erasmus MC modification of the revised Nottingham Sensory Assessment; TFT = Thumb Finding Test; Statistically significant adequate correlations

Ischemic or Hemmorhagic Stroke: (Bertrand et al., 2015; n = 34)

Participants were recruited from an acute neurology ward after their first stroke, and were administered the MI Arm, Chedoke Arm and Hand Activity Inventory (CAHAI), and the ABILHAND questionnaire.

• Excellent concurrent validity between the MI Arm and the CAHAI at weeks 2, 4, 8, and 12 (r = 0.87-0.94)
• Excellent concurrent validity between the MI Arm at weeks 1, 2, 4, 8, and 12 and the ABILHAND at week 12 (r = 0.69-0.82)

Subacute/Chronic Stroke: (Collin & Wade ,1990)

• Excellent convergent validity of the MI arm score and the MI leg score with the Rivermead Motor Assessment

Weeks Post Stroke

RMA Arm vs MI Arm

RMA Leg vs MI Leg

6 (n = 27)

0.76**

0.81**

12 (n = 25)

0.73**

0.81**

18 (n = 14)

0.74*

0.75*

**p < 0.001; *p < 0.01; RMA = Rivermead Motor Assessment; MI = Motricity Index

When the Motricity Index was initially developed, Demeurisse et al. (1980, p. 388) applied a Hotelling’s analysis and determined that, “because of the nearness of these coefficients, the sum of the values of the six items in question is a good measurement of analytical motricity.”

Content validity was not discussed in the literature. The Motricity Index, however, is often used when examining validity, reliability and responsiveness of other rehab measures (Wade, 1988; Benaim et al., 1999; Bertrand et al., 2015)

Upper Extremity:

• Adequate ceiling effects: 100% of participants scored above midpoint; 18% gained maximum score (Jacob-Lloyd et al., 2005)
• A comparison of grip strength among the Frenchay Arm Test, the Motor Club, the 9-Hole Peg Test and the MI revealed floor effects on admission for the Frenchay and Peg Test, yet the MI demonstrated 57% of patients had measurable pinch grip within first 3 weeks of stroke; only 2% had normal pinch grip (Sunderland et al., 1989).
• When all patients were examined 0% showed a floor effect and 28% showed a ceiling effect with respect to the MI Arm.
• In the subgroup with MI Arm score <100, 0% of patients had a floor or ceiling effect (Arwert et al., 2016)

Lower Extremity:

• Poor ceiling effects: 76% of participants scored at or above midpoint; 24% gained maximum score (Jacob-Lloyd et al., 2005)

Upper Extremity:

• Large responsiveness (ES = 0.91, Z = 5.45, p < 0.001) to detecting changes < 3 months after stroke. Measurements were done within the first 72h of admission and on the last day of hospital stay (Safaz et al., 2009).
• Increase observed for MI tests administered 6 weeks apart, but no statistical measure noted (Collin & Wade, 1990)
• Moderate sensitivity to detecting change < 3 months after stroke (Effect Size = .70) (Sunderland et al., 1989; n = 31; assessed at initial-1 month; 1-3 months)
• Small sensitivity to detecting change > 3 months after stroke (Effect size = .29) (Sunderland et al., 1989; n = 31; assessed at 3-6 months)

Lower Extremity:

• Small sensitivity to detecting change in the acute phase. Mean number of days between tests = 9.6 days (effect size = .30; SRM = 1.0) (Vos-Vromans et al., 2005).