AUTHOR=Tsai Han-ting , Lau Hiu-ying , Lin Keh-chung , Li Yi-chun , Lin Chia-jung , Yao Grace , Lee Ya-yun , Chen Wen-shiang , Chen Chia-ling , Chang Ya-ju , Horng Yi-shiung 

TITLE=Responsiveness and construct validity of two outcome measures of bilateral upper limb function in patients with chronic stroke

JOURNAL=Frontiers in Neurology

VOLUME=15

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1352365

DOI=10.3389/fneur.2024.1352365

ISSN=1664-2295

ABSTRACT=<sec id="sec1"><title>Background</title><p>Stroke is a leading cause of long-term disability among stroke survivors. Despite the availability of numerous stroke rehabilitative therapies, such as mirror therapy, bilateral arm training, and robot-assisted therapy, the recovery of motor function after stroke remains incomplete. Bilateral arm function is a key component in stroke patients to perform activities of daily living and to reflect their functional autonomy.</p></sec><sec id="sec2"><title>Objective</title><p>This clinimetric study investigated and compared the construct validity and responsiveness of 2 bimanual activity outcome measures, the Chedoke Arm and Hand Activity Inventory (CAHAI) and the ABILHAND Questionnaire, in individuals receiving stroke rehabilitation.</p></sec><sec id="sec3"><title>Methods</title><p>The present study is a secondary analysis following the framework of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Individuals with chronic stroke (<italic>N</italic> = 113) were recruited from outpatient rehabilitation settings. Participants received 18 to 20 sessions of robot-assisted therapy, mirror therapy, combined therapy, or conventional rehabilitation for 4 to 6 weeks. The CAHAI, ABILHAND Questionnaire, and a comparison instrument, the Motor Activity Log (MAL), were administered twice at a 4- to 6-week interval to all participants. ABILHAND scores, in logits, were converted from raw ordinal scores into a linear measure.</p></sec><sec id="sec4"><title>Results</title><p>There was medium to large correlation of the CAHAI and the MAL (<italic>ρ</italic> = 0.60–0.62, <italic>p</italic> &lt; 0.01) as well as the ABILHAND Questionnaire and the MAL (<italic>ρ</italic> = 0.44–0.51, <italic>p</italic> &lt; 0.01). Change scores from the initial measurement to the post-intervention measurement demonstrated small to medium correlation of the CAHAI and the MAL (<italic>ρ</italic> = 0.27–0.31, <italic>p</italic> &lt; 0.01) and medium to large correlation of the ABILHAND Questionnaire and the MAL (<italic>ρ</italic> = 0.37–0.41, <italic>p</italic> &lt; 0.01). Overall, 7 of 8 hypotheses were supported. The hypothesis testing regarding the construct validity and responsiveness of the CAHAI and ABILHAND Questionnaire was confirmed.</p></sec><sec id="sec5"><title>Conclusion</title><p>The CAHAI and ABILHAND Questionnaire are both responsive and suitable to detect changes in bilateral arm functional daily activities in individuals with chronic stroke. Patient-reported outcome measures are recommended to use along with therapist-rated outcome measures for upper limb capacity evaluation in stroke rehabilitation. Further study with a prospective study design to capture specific clinical features of participants and the use of body-worn sensors, such as the arm accelerometer, is suggested.</p></sec>