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A cohort study investigating a simple, early assessment to predict upper extremity function after stroke - a part of the SALGOT study.

Persson HC, Alt Murphy M, Danielsson A, Lundgren-Nilsson Å, Sunnerhagen KS - BMC Neurol (2015)

Bottom Line: Previous studies demonstrate correct prediction of function, but have ether included a complex assessment procedure or have an outcome that does not automatically correspond to motor function required to be useful in daily activity.Correctly classified patients varied between 81% and 96%.ARAT-2 demonstrates high predictive values, is easily performed and has the potential to be clinically feasible.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. hanna.persson@neuro.gu.se.

ABSTRACT

Background: For early prediction of upper extremity function, there is a need for short clinical measurements suitable for acute settings. Previous studies demonstrate correct prediction of function, but have ether included a complex assessment procedure or have an outcome that does not automatically correspond to motor function required to be useful in daily activity. The purpose of this study was to investigate whether a sub-set of items from the Action Research Arm Test (ARAT) at 3 days and 1 month post-stroke could predict the level of upper extremity motor function required for a drinking task at three later stages during the first year post-stroke.

Methods: The level of motor function required for a drinking task was identified with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). A structured process was used to select ARAT items not requiring special equipment and to find a cut-off level of the items' sum score. The early prognostic values of the selected items, aimed to determine the level of motor function required for a drinking task at 10 days and 1 and 12 months, were investigated in a cohort of 112 patients. The patients had a first time stroke and impaired upper extremity function at day 3 after stroke onset, were ≥18 years and received care in a stroke unit.

Results: Two items, "Pour water from glass to glass" and "Place hand on top of head", called ARAT-2, met the requirements to predict upper extremity motor function. ARAT-2 is a sum score (0-6) with a cut-off at 2 points, where >2 is considered an improvement. At the different time points, the sensitivity varied between 98% and 100%, specificity between 73% and 94%. Correctly classified patients varied between 81% and 96%.

Conclusions: Using ARAT-2, 3 days post-stroke could predict the level of motor function (assessed with FMA-UE) required for a drinking task during the first year after a stroke. ARAT-2 demonstrates high predictive values, is easily performed and has the potential to be clinically feasible.

Trail registration: ClinicalTrials.gov: NCT01115348.

No MeSH data available.


Related in: MedlinePlus

Illustration of the selection process to identify items from the Action Research Arm Test (ARAT) feasible for clinical use in the acute stage to predict the motor function required for a drinking task (FMA-UE ≥32 points), within the first year after stroke
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Fig2: Illustration of the selection process to identify items from the Action Research Arm Test (ARAT) feasible for clinical use in the acute stage to predict the motor function required for a drinking task (FMA-UE ≥32 points), within the first year after stroke

Mentions: The ARAT [4–6] consists of 19 items, and the performance of each item is scored on a 4-point ordinal scale ranging from 0 (no task performance) to 3 (normal task performance) and summed to a total score of 0-57. The ARAT was performed in a standardized manner [6, 20] at 3 days and 1 month post-stroke. These time-points were considered as being of possible clinical importance for both early and long term rehabilitation planning. The procedure for choosing a sub-set of items from the ARAT was conducted in four steps (Fig. 2): 1) items not requiring special equipment were identified (consensus among the authors and physiotherapists at the stroke unit); 2) the minimum number of items needed to capture most of the variance in the ARAT at day 3 was explored; 3) according to published results of a Mokken scale analysis [21], items identified by their means as highest or lowest in degree of difficulty were excluded; and 4) from the same analysis [21] the two remaining items with the greatest distance in their means were selected, in order to identify UE function at various degrees of stroke severity. From the selected sub-set of ARAT items, a cut-off level with potential to be clinically useful was determined where a higher score indicates better function.Fig. 2


A cohort study investigating a simple, early assessment to predict upper extremity function after stroke - a part of the SALGOT study.

Persson HC, Alt Murphy M, Danielsson A, Lundgren-Nilsson Å, Sunnerhagen KS - BMC Neurol (2015)

Illustration of the selection process to identify items from the Action Research Arm Test (ARAT) feasible for clinical use in the acute stage to predict the motor function required for a drinking task (FMA-UE ≥32 points), within the first year after stroke
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4471915&req=5

Fig2: Illustration of the selection process to identify items from the Action Research Arm Test (ARAT) feasible for clinical use in the acute stage to predict the motor function required for a drinking task (FMA-UE ≥32 points), within the first year after stroke
Mentions: The ARAT [4–6] consists of 19 items, and the performance of each item is scored on a 4-point ordinal scale ranging from 0 (no task performance) to 3 (normal task performance) and summed to a total score of 0-57. The ARAT was performed in a standardized manner [6, 20] at 3 days and 1 month post-stroke. These time-points were considered as being of possible clinical importance for both early and long term rehabilitation planning. The procedure for choosing a sub-set of items from the ARAT was conducted in four steps (Fig. 2): 1) items not requiring special equipment were identified (consensus among the authors and physiotherapists at the stroke unit); 2) the minimum number of items needed to capture most of the variance in the ARAT at day 3 was explored; 3) according to published results of a Mokken scale analysis [21], items identified by their means as highest or lowest in degree of difficulty were excluded; and 4) from the same analysis [21] the two remaining items with the greatest distance in their means were selected, in order to identify UE function at various degrees of stroke severity. From the selected sub-set of ARAT items, a cut-off level with potential to be clinically useful was determined where a higher score indicates better function.Fig. 2

Bottom Line: Previous studies demonstrate correct prediction of function, but have ether included a complex assessment procedure or have an outcome that does not automatically correspond to motor function required to be useful in daily activity.Correctly classified patients varied between 81% and 96%.ARAT-2 demonstrates high predictive values, is easily performed and has the potential to be clinically feasible.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. hanna.persson@neuro.gu.se.

ABSTRACT

Background: For early prediction of upper extremity function, there is a need for short clinical measurements suitable for acute settings. Previous studies demonstrate correct prediction of function, but have ether included a complex assessment procedure or have an outcome that does not automatically correspond to motor function required to be useful in daily activity. The purpose of this study was to investigate whether a sub-set of items from the Action Research Arm Test (ARAT) at 3 days and 1 month post-stroke could predict the level of upper extremity motor function required for a drinking task at three later stages during the first year post-stroke.

Methods: The level of motor function required for a drinking task was identified with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). A structured process was used to select ARAT items not requiring special equipment and to find a cut-off level of the items' sum score. The early prognostic values of the selected items, aimed to determine the level of motor function required for a drinking task at 10 days and 1 and 12 months, were investigated in a cohort of 112 patients. The patients had a first time stroke and impaired upper extremity function at day 3 after stroke onset, were ≥18 years and received care in a stroke unit.

Results: Two items, "Pour water from glass to glass" and "Place hand on top of head", called ARAT-2, met the requirements to predict upper extremity motor function. ARAT-2 is a sum score (0-6) with a cut-off at 2 points, where >2 is considered an improvement. At the different time points, the sensitivity varied between 98% and 100%, specificity between 73% and 94%. Correctly classified patients varied between 81% and 96%.

Conclusions: Using ARAT-2, 3 days post-stroke could predict the level of motor function (assessed with FMA-UE) required for a drinking task during the first year after a stroke. ARAT-2 demonstrates high predictive values, is easily performed and has the potential to be clinically feasible.

Trail registration: ClinicalTrials.gov: NCT01115348.

No MeSH data available.


Related in: MedlinePlus