The Adult Assisting Hand Assessment Stroke: Psychometric properties of an observation-based bimanual upper-limb performance measurement.

Abstract

To investigate interrater and intrarater reliability, measurement error and convergent and discriminative validity of the Adult Assisting Hand Assessment Stroke (Ad-AHA Stroke). Cross-sectional observational study SETTING: Seven stroke rehabilitation centers PARTICIPANTS: A total of 118 stroke survivors (reliability sample: n=30; validity sample: n=118) were included (median age 67 years (interquartile range (IQR) 59-76); median time post stroke 81 days (IQR 57-117). N/A. Ad-AHA Stroke, Action Research Arm Test (ARAT), Upper Extremity Fugl-Meyer assessment (UE-FMA). The Ad-AHA Stroke is an observation-based instrument assessing the effectiveness of the spontaneous use of the affected hand when performing bimanual activities in adults after stroke. Reliability of Ad-AHA stroke was examined using intraclass correlation coefficients (ICC), Bland-Altman plots, and weighted kappa (Kw) statistics for reliability on item level. Standard error of measurement (SEM) was calculated based on Ad-AHA units. Convergent validity was assessed by calculating Spearman rank correlation coefficients between Ad-AHA stroke and ARAT and UE-FMA. Comparison of Ad-AHA stroke scores between subgroups of patients according to hand dominance, neglect and age evaluated discriminative validity. Intrarater and interrater agreement showed an ICC of 0.99 (95% CI=0.99-0.99), a SEM of 2.15 and 1.64 out of 100, respectively and Kw for item scores were all above 0.79. The relation between Ad-AHA and other clinical assessments was strong (rs=0.9). Patients with neglect had significantly lower Ad-AHA scores compared to patients without neglect (p=0.004). The Ad-AHA Stroke captures actual bimanual performance. Thereby it provides an additional aspect of upper limb assessment with good to excellent reliability and low SEM for patients with sub-acute stroke. High convergent validity with ARAT and UE-FMA and discriminative validity was supported.