Journal of Rehabilitation Medicine 51-4inkOmslag | Page 27

Short assessment for upper extremity after stroke
261
trials. These time-points were based on
what is known about the neural repair
process and the measurements tools were
identified through existing recommen-
dations. The SRRR recommended using
the FMA-UE and ARAT as assessment
for impairment and activity limitation,
respectively. The assessments should,
according to the SRRR, be performed
within 7 days after stroke onset and fol-
lowed up at set time-points until at least
3 months post-stroke. Both FMA-UE
and ARAT are, however, rarely used in
acute settings since they are considered
to be time consuming, require training
Fig. 3. Proportion of patients showing positive, negative or no changes in assessment
scores between the 3 time-points. ARAT-2: short version of Action Research Arm Test;
and as in case of ARAT require spe-
ARAT: Action Research Arm Test; FMA-UE: Fugl-Meyer Assessment for Upper Extremity.
cial equipment (26, 35). Similarly to our
study, there have been other suggestions
The ARAT-2 and the ARAT both showed a floor ef-
for shorter tests. A short version of the
fect at 3 days (both 38%), 10 days (31% and 30%) and
FMA-UE (S-FM), including 6 items, showed good
4 weeks (both 24%) post-stroke (Table II). No floor
concurrent validity with the original FMA-UE (≥ 0.93)
effect was observed in the FMA-UE, but similarly to
at subacute and chronic stages after stroke (35). The
ARAT-2 and ARAT, the floor effect was also present
responsiveness of the S-FM was, however, moderate
in the FMA-UE without reflex items at 3 days (35%)
and should be interpreted with caution, as the calcula-
and 10 days (27%), but not at 4 weeks (12%) post-
tions did not take into account the ordinal nature of
stroke. There was a ceiling effect detected for ARAT-2
the data (35).
at 10 days (22%) and 4 weeks (32%) in contrast to
ARAT-2 is a short assessment and, according to the
the ARAT that showed a small ceiling effect only at
present study, suitable for use in stroke units early after
4 weeks (21%). The FMA-UE and FMA-UE without
stroke. The ARAT-2 consists of items that require some
reflex did not show any ceiling effect within the first
shoulder abduction and finger extension, which are
4 weeks post-stroke.
important early signs to predict UE activity capacity
at 6 months post-stroke (36). A previous study has
also shown that ARAT-2 predicts well the expected
DISCUSSION
UE function required for use of the affected arm
when drinking from a glass at later time-points (21).
This study investigated the concurrent validity, re-
For example, the ARAT-2 score of 2 or more points,
sponsiveness, floor and ceiling effects of the ARAT-2
assessed at 3 days post-stroke, have showed a high
in comparison with the original ARAT and the FMA-
probability for prediction of arm function at 10 days as
UE within the first 4 weeks after stroke onset. The
well as at 12 months post-stroke (21). Similarly to other
ARAT-2 showed a strong correlation with the original
clinical scales the accuracy for prediction of long-term
ARAT and FMA-UE and was, similarly to other scales,
outcome for those with no or very little initial arm and
sensitive to change between all tested time-points, (3
hand function was less precise (21). The results of the
days, 10 days, and 4 weeks, respectively) post-stroke.
current study are, however, promising and suggest that
The ARAT-2 had similar floor effect compared with
a shorter version of an established clinical scale might
the ARAT at all time-points, but showed a ceiling
be useful in the clinical acute settings after stroke.
effect already at 10 days post-stroke, compared with
The present study showed that ARAT-2 and ARAT
ARAT, which showed a ceiling effect first at 4 weeks
both showed a floor effect up to 4 weeks post-stroke.
post-stroke.
Similarly to our results, previous studies have reported
In order to improve the research methodology
a floor effect of the ARAT at 2 weeks post-stroke (26,
of rehabilitation and recovery trials after stroke, an
37). The floor effect in our sample was also detected
international consensus group, the Stroke Recovery
for the pure motor FMA-UE without reflexes at 3 and
and Rehabilitation Roundtable (SRRR), developed
10 days, but not at 4 weeks post-stroke. On the other
recommendations for standardized assessment (34).
hand, the FMA-UE including the reflex items showed
The SRRR lists the time-points and measurements that
no floor and ceiling effect during the first 4 weeks
should be included in stroke rehabilitation and recovery
J Rehabil Med 51, 2019