Original article
Test-Retest Reliability, Validity, and Sensitivity of the Chedoke Arm and Hand Activity Inventory: A New Measure of Upper-Limb Function for Survivors of Stroke

https://doi.org/10.1016/j.apmr.2005.03.017Get rights and content

Abstract

Barreca SR, Stratford PW, Lambert CL, Masters LM, Streiner DL. Test-retest reliability, validity, and sensitivity of the Chedoke Arm and Hand Activity Inventory: a new measure of upper-limb function for survivors of stroke.

Objectives

To estimate the test-retest reliability and validity of the Chedoke Arm and Hand Activity Inventory (CAHAI) and to test whether the CAHAI was more sensitive to change in upper-limb function than the Impairment Inventory of the Chedoke-McMaster Stroke Assessment (CMSA) and the Action Research Arm Test (ARAT).

Design

Construct validation process.

Setting

Inpatient/outpatient rehabilitation facilities.

Participants

Stratified sample of 39 survivors of stroke: 24 early (mean age, 71.4y; mean days poststroke, 27.3) and 15 chronic (mean age, 64.0y; mean days poststroke, 101.7).

Intervention

Regular therapy.

Main Outcome Measures

Intraclass correlation coefficients (ICCs), receiver operating characteristic (ROC), standard error of measurement, and correlation coefficients.

Results

High interrater reliability was established with an ICC of .98 (95% confidence interval [CI], .96–.99). The minimal detectable change score was 6.3 CAHAI points. Higher correlations were obtained between the CAHAI and the ARAT and CMSA scores compared with the CMSA shoulder pain scores (1-sided, P=.001). Areas under the ROC curves were as follows: CAHAI, .95 (95% CI, 0.87–1.00); CMSA, .76 (95% CI, .61–.92); and ARAT, .88 (95% CI, 0.76–1.00).

Conclusions

High interrater reliability and convergent and discriminant cross-sectional validity were established for the CAHAI. The CAHAI is more sensitive to clinically important change than the ARAT.

Section snippets

Participants

A prospective cohort of 39 participants with a complete first episode of stroke (table 1) met the study’s inclusion criteria. Stroke survivors were excluded if they (1) had a lower motoneuron injury, (2) had a preexisting disability of the arm or hand apart from the stroke, (3) lacked sufficient stamina to participate, or (4) achieved a combined CMSA score greater than 11 (because there would be no room for change [improvement] over time).

Chedoke Arm and Hand Activity Inventory

The CAHAI is a functional measure with 13 items that are

Descriptive Analysis

Table 2 provides a summary of the descriptive analysis.

Reliability

The 3-way ANOVA produced an ICC of .98 for the CAHAI. Because the rater variance was zero, this factor was removed and the analysis was repeated using a 2-way ANOVA. The ICC2,136 was .98 (95% confidence interval [CI], .96–.99). The SE of measurement was 2.8 CAHAI points (95% CI, 2.3–3.7). The 90% CI for a patient’s score at a single point in time was ±4.6 CAHAI points and the MDC90 was 6.3 CAHAI points. MDC90 means that 90% of stable

Discussion

Before the development of the CAHAI, outcome measures of upper-extremity function often incorporated unilateral nonfunctional tasks, lacked theoretic constructs and interval scaling, or were not validated solely for the stroke population. The CAHAI was conceived to overcome these shortcomings by combining survivors’ preferences with items generated from the literature and experienced clinicians into a meaningful and relevant evaluation of upper-limb function. This study provides ongoing

Conclusions

A priority of future research of the paretic arm and hand will be to ascertain effective treatment interventions and to identify those survivors of stroke who have the potential to change and benefit from intensive therapy. The success of such research will be aided greatly by a valid measure that is most sensitive to clinically important change. As well, a critical step in convincing clinicians of the need to incorporate patient preferences into a measure is to document the advantages of such

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    • Supported by the Ontario Ministry of Health and Long Term Care through the Heart and Stroke Foundation of Ontario Initiative.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the author(s) is/are associated.

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    Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.