Purpose
The RMA assesses functional mobility following stroke (e.g., gait, balance, and transfers).
Link to Instrument
Acronym
RMA
Primary Image
Rivermead Motor Assessment
Expertise, Instruction and Mentorship
Center for Smart Use of Technologies to Assess Real World Outcomes (C-STAR)
Upcoming Stroke Course
May 9–10
Live and Online
Offered by Academy, Shirley Ryan AbilityLab
Populations
Key Descriptions
- RMA is a performance-based measure developed specifically for the stroke population with the intent to be used for both the clinic and research purposes.
- Consists of 3 sections:
1) gross function (RMA-gf)
2) leg and trunk (RMA-lt)
3) arm (RMA-a). - Each item is scored either yes ‘1’ or no ’0’. It is based on Guttman scaling, which presumes that each subsequent item is of a more difficult nature. To advance to the next question, one must score “1” on an item, otherwise the test is stopped.
Number of Items
38
Equipment Required
- Block of 20 cm height
- Pencil
- Volleyball
- Tennis ball
- Piece of paper
- Fork and knife
- Plate and container (use box of putty as container)
- Beanbag
- Cord
- Putty
- Watch with chronometer
- Non-slip mat
Time to Administer
45 minutes
Required Training
No TrainingAge Ranges
Adults
18 - 64
yearsOlder Adults
65 +
yearsInstrument Reviewers
Originally included in StrokEDGE; Reviewed by Heather Anderson and Rie Yoshida; Updated by StrokEdge II Task Force in April 2016
Body Part
Upper ExtremityLower Extremity
ICF Domain
ActivityMeasurement Domain
MotorProfessional Association Recommendation
Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Stroke Taskforce (StrokEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations
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Abbreviations: |
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HR |
Highly Recommend |
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R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations based on level of care in which the assessment is taken:
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Acute Care |
Inpatient Rehabilitation |
Skilled Nursing Facility |
Outpatient Rehabilitation |
Home Health |
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StrokEDGE |
NR |
R |
R |
R |
NR |
Recommendations for entry-level physical therapy education and use in research:
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Students should learn to administer this tool? (Y/N) |
Students should be exposed to tool? (Y/N) |
Appropriate for use in intervention research studies? (Y/N) |
Is additional research warranted for this tool (Y/N) |
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Strok |
No |
Yes |
Yes |
Yes |
Considerations
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Used extensively in research and clinic, primarily in Europe.
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Designed for the stroke population and used primarily with that population. Gross motor section has been used with TBI and the elderly to a lesser extent.
- Several studies have noted that their results show the actual hierarchy of the test items to be different from the original test. Therefore, when administering the test, it is recommended that all items be tested rather than stopping the arm or gross functions test when 3 consecutive items are scored a “0”, as originally instructed.
Stroke
back to PopulationsMinimally Clinically Important Difference (MCID)
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Collen et al (1990) found that a 3 point change in the total RMA score represented a clinically meaningful change.
Test/Retest Reliability
Stroke: (Lincoln and Leadbitter 1979)
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Adequate test-retest reliability
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RMA-gf, r = 0.66
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RMA-lt, r = 0.93
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RMA-a, r = 0.88
Internal Consistency
Subacute Stroke: (Kurtais et al, 2009; n = 107; mean age = 62.4 (12.8) years; mean time since onset = 5.6 (SD = 11.2, range = 0.5-78) months; patients in inpatient rehabilitation unit)
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Good internal consistency
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RMA-gf - Cronbach’s Alpha = 0.93, ICC = 0.88
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RMA-lt - Cronbach’s Alpha = 0.88, ICC = 0.84
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RMA-a - Cronbach Alpha = 0.95, ICC = 0.93
Criterion Validity (Predictive/Concurrent)
Concurrent Validity
Chronic Stroke: (Rousseaux et al, 2012; n = 46; 14.1 (25.9) months post stroke)
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Excellent validity with Upper Limb Assessment in Daily Living (ULADL): correlation of Global Questionnaire (Q) and Test scores (T) with Rivermead Gross Motor Assessment (RMA score) (r = 0.80 and 0.88, respectively; p < 10-4)
Predictive Validity
Chronic Stroke: (Collen and Wade, 1990):
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Low RMA scores at 6 weeks post stroke predicted poor prognosis to ambulate.
Construct Validity
Acute to Subacute Stroke: (Soyuer and Soyuer 2005)
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High convergent validity between total RMA and FIM
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7-10 days post stroke: r = 0.87 for total FIM, r = 0.90 for motor FIM
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3 months post stroke: r = 0.88 for total FIM, r = 0.89 for motor FIM
Subacute Stroke: (Kurtais et al, 2009; n = 107; mean age = 62.4 (12.8) years; mean time since onset = 5.6 (SD = 11.2, range = 0.5-78) months; patients in inpatient rehabilitation unit)
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Moderate to High external construct validity when compared to FIM score
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Admission |
Discharge |
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FIM Motor |
FIM Self-Care |
FIM Mobility |
FIM Motor |
FIM Self-Care |
FIM Mobility |
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RMA-gf |
0.865 |
0.815 |
0.844 |
0.820 |
0.757 |
0.817 |
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RMA-lt |
0.784 |
0.726 |
0.782 |
0.747 |
0.702 |
0.764 |
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RMA-a |
0.386 |
0.390 |
0.386 |
0.467 |
0.480 |
0.483 |
Spearman r; p < 0.001
Chronic Stroke: (Van de Winckel et al, 2007; mean time post stroke = 8 months; RMA-a only)
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Investigated the construct validity and unidimensionality of the RMA-a. Four items were removed from the scale and 2 subsets were identified through statistical analysis to create a scale that fit the Rasch model. The revised RMA-arm section met criteria for validity and unidimensionality.
Acute-Subacute Stroke: (Houwink et al, 2011; n = 21; mean age = 61.7 ± 7.9 years; time since stroke onset = within 4 months; only used RMA-a)
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Strong cross-sectional correlation of RMA-a with SULCS (Stroke Upper Limb Capacity Scale) with ρ = 0.85
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Moderate longitudinal correlation of RMA-a with SULCS (ρ = 0.48)
Responsiveness
Subacute Stroke: (Kurtais et al, 2009; n = 107; mean age = 62.4 (12.8) years; mean time since onset = 5.6 (SD = 11.2, range = 0.5-78) months; patients in inpatient rehabilitation unit)
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Good sensitivity
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RMA-gf ES = 0.51, SRM = 0.83
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RMA-lt ES = 0.45, SRM = 0.86
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RMA-a ES = 0.61, SRM = 1.20
Brain Injury
back to PopulationsCriterion Validity (Predictive/Concurrent)
Concurrent Validity
Brain Injury: (Endres et al, 1990)
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RMA has excellent correlation with BI across each assessment period initial (r = 0.84), one month (0.78), and one year (0.63).
Floor/Ceiling Effects
TBI: (Williams et al, 2006)
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A Large ceiling effect was noted on the Gross Motor Function Subscale of the RMA when compared to HIMAT ceiling effect was noted on the Gross Motor Function Subscale of the RMA when compared to HIMAT
Bibliography
Collen FM, Wade DT, Bradshaw CM. Mobility after stroke: reliability of measures of impairment and disability. Int Disabil Stud. 1990;12:6-9. Find it on PubMed
Collin C, Wade D. Assessing motor impairment after stroke: A pilot reliability study. J Neurol Neurosur PS 1990;53:576-9. Find it on PubMed
Endres M, Nyary I, Banhidi M, Deak G. Stroke rehabilitation: a method and evaluation. Int J Rehabil Res. 1990;13:225-36. Find it on PubMed
Houwink A, Roorda LD, Smits W, Molenaar IW, Geurts AC. Measuring upper limb capacity in patients after stroke: reliability and validity of the stroke upper limb capacity scale. Arch Phys Med Rehab. 2011 Sep;92(9):1418-22. Find it on PubMed
Kurtais Y, Kucukdeveci A, Elhan A, et al. Psychometric properties of the Rivermead Motor Assessment: its utility in stroke. J Rehabil Med 2009;41:1055-61. Find it on PubMed
Lincoln N, Leadbitter D. Assessment of motor function in stroke patients. Physiotherapy 1979;65:48-51. Find it on PubMed
Rousseaux M, Bonnin-Koang HY, Darne B, et al. Construction and pilot assessment of the Upper Limb Assessment in Daily Living Scale. J Neurol Neurosur PS. 2012;83(6):594-600. Find it on PubMed
Soyuer F, Soyuer A. Ischemic stroke: motor impairment and disability with relation to age and lesion location (Turkish). Journal of Neurological Sciences 2004;22(1):43-49.
Van de Winckel A, Feys H, Lincoln N, De Weerdt W. Assessment of arm function in stroke patients: Rivermead Motor Assessment arm section revised with Rasch analysis. Clin Rehabil 2007;21:471-9. Find it on PubMed
Williams G, Robertson V, Greenwood K, Goldie P, Morris ME. The concurrent validity and responsiveness of the high-level mobility assessment tool for measuring the mobility limitations of people with traumatic brain injury. Arch Phys Med Rehab 2006;87(3):437-42. Find it on PubMed