Jamal K, Butet S, Maitre B, Gracies JM, Hameau S, Leveque LE Bras É, Baude M, Cordillet S, Bonan I. Validity and reliability of the chronic composite XA, an upper limb motor assessment using Active Range of Motion in patients with chronic stroke.
Eur J Phys Rehabil Med 2024;
60:559-566. [PMID:
38958692 DOI:
10.23736/s1973-9087.24.08463-6]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND
Upper limb (UL) spastic paresis has been classically evaluated with assessments of passive movements with limited functional validity. The aim of this study was to assess whether a composite measure of active range of motion (AROM, or XA) is valid and reliable in chronic post-stroke spastic paresis.
AIM
The primary objective was to investigate the validity and reliability of a composite score, comprising multiple XA measurements, to assess UL spastic paresis in patients in chronic stages post-stroke. In addition to this, an exploratory analysis was conducted to identify which muscles should be optimally included in this composite score.
DESIGN
A psychometric proprieties study.
SETTING
Physical and Rehabilitation Medicine Department.
POPULATION
twenty-eight chronic post-stroke participants with spastic paresis.
METHODS
Composite UL XA measurement in twenty-eight chronic post-stroke participants (age=59±11 years; delay post-stroke=29±37 months) with spastic paresis was repeated twice about 40 days apart in a standardized body position. Concurrent and construct validity was evaluated exploring correlation with the Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and grip strength (JAMAR™). Reliability was assessed by calculating intraclass correlation coefficients (ICC). Regarding the exploratory analysis, a linear regression analysis was performed to examine the value of including various muscles.
RESULTS
Composite XA against the resistance of elbow, wrist and finger flexors showed strong correlation with FMA-UE and ARAT (r=0.88; P<0.001 and r=0.82; P<0.001 respectively) and a weak association with grip strength (r=0.43; P=0.03). Test-retest reliability was excellent (ICC=0.92). However, the most effective regression model also included XA against the resistance of shoulder adductors as well as forearm pronator (adjusted R2=0.85; AIC=170).
CONCLUSIONS
The present study provided satisfactory psychometric data for the upper limb composite active movement (CXA), derived from the Five Step Assessment. For overall measurement of UL mobility after stroke, we strongly recommend including shoulder and forearm muscles to the score.
CLINICAL REHABILITATION IMPACT
Composite XA is a valid and reliable measure of upper limb motor function in chronic post-stroke patients and could be used in clinical practice and research.
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