A performance test for assessment of upper limb function in physical rehabilitation treatment and research

Abstract

Development of a rapid, reliable and standardized performance test appropriate for use in assessing recovery of upper limb function following cortical damage is reported. Hemiplegic patients (20) were first assessed on a range of performance measures involving upper limb functions such as grasp, grip, lateral prehension, finger-thumb opposition, pronation and supination, by independent raters, on 2 occasions. Interrater and test-retest reliabilities were + 0.99 and +0.98, respectively. The test was further refined by correlational analysis of items to yield 4 subscales: grasp, grip, pinch and gross movement, each with items arranged in hierarchical order of difficulty. Success with the most difficult item predicted success with items of lesser difficulty on that subscale; failure with the easiest item predicted failure with all more difficult subscale items. All subscales fulfilled the statistical criteria for Guttman scales. A computer simulation indicated reductions of 67-87% in test length through reliance on the hierarchical properties of the Guttman scales in testing. A cross-validation of this Action Research Armtest confirmed the validity of the hierarchical scoring procedure when used with 50 patients having a far wider spread of diagnosis, including amputees and arthritic patients. The Action Research Armtest has wide potential application in the rehabilitation of hemiplegia. In addition to its obvious use in monitoring progress within treatment, it can also be used to evaluate treatment in a clinical or research context, where it confers the important advantages of reliability and rapidity. Although it is a highly specific measure of changes in limb function, it also bears a wider relation to empirically derived scales of activities of daily living.