Article

OBJECTIVE: To validate the internal construct and predictive validity of the
Action Research Arm Test (ARAT). DESIGN: Secondary study. SETTING: Seven medical
centers. PARTICIPANTS: Patients with stroke (N=191). INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURE: The internal construct validity of the ARAT
score at pretreatment was examined using Rasch analysis. The predictive validity
was examined by the correlations between performance on the ARAT before treatment
and scores on the Wolf Motor Function Test, the Motor Activity Log, and the
Stroke Impact Scale after treatment. RESULTS: The 4-point ARAT scale had a
disordered rating scale structure. Further Rasch modeling suggested revising the
original 4-point scale into a 3-point scale. The 19 items measured 1 construct.
The item difficulty hierarchy indicated that excluding the gross subtest, a score
of 3 on the first item of any other subtest indicated the highest motor ability,
and a score of 1 (the revised lowest rating) on the second item indicated the
lowest motor ability. Tasks of "place hand behind head" and "place hand on top of
head" showed poor item fit and item bias relevant to participants' ages. The ARAT
items can reliably separate participants into 5.44 strata. Moderate to good
correlations indicated good predictive validity. CONCLUSIONS:
The ARAT possesses
good psychometric properties in stroke patients with mild to moderate motor
severity and without severe cognitive impairment, and has evidence of
unidimensionality, predictive validity, and reliability. The revised 3-point
rating scale is recommended when the ARAT is administered on this population. The
"place hand behind head" and "place hand on top of head" tasks misfit the Rasch
model's expectations. Future studies are needed in the use of the ARAT on stroke
patients with different levels of motor severity or with cognitive impairment.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS