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A Revised Motor Activity Log Following Rasch Validation (Rasch-Based MAL-18) and Consensus Methods in Chronic Stroke
Ann Van de Winckel1, Lynne Gauthier2
1University of Minnesota, Minneapolis, MN, USA.
A new 18-item Motor Activity Log Quality-of-Movement Scale (MAL-18) demonstrates strong validity and reliability for assessing upper-extremity function in chronic stroke and MS patients. This revised scale improves clinical utility and treatment response measurement.
Area of Science:
- Rehabilitation Science
- Psychometrics
- Neurology
Background:
- The Motor Activity Log Quality-of-Movement Scale (MAL-28) is a lengthy instrument for assessing upper-extremity function.
- Chronic stroke and multiple sclerosis (MS) patients with hemiparesis require valid and reliable measures for functional recovery.
- Enhancing the content and construct validity of the MAL-28 can improve its clinical applicability.
Purpose of the Study:
- To develop and validate a shorter version of the Motor Activity Log Quality-of-Movement Scale (MAL-18).
- To ensure the revised scale possesses enhanced content and construct validity for individuals with chronic upper-extremity hemiparesis.
- To establish the psychometric properties of the MAL-18 using Rasch Measurement Theory.
Main Methods:
- A validation cohort of 149 adults with chronic mild/moderate upper-extremity hemiparesis (stroke or MS) was analyzed retrospectively.
- Rasch Measurement Theory was applied to assess item fit, targeting, reliability (PSI), and dependencies.
- Content validity was rated by expert examiners, and test-retest reliability was calculated.
Main Results:
- An 18-item MAL (MAL-18) demonstrated established content and construct validity, fitting the Rasch model well.
- The MAL-18 exhibited minimal floor (12.08%) and ceiling (0%) effects, with acceptable reliability (PSI = 0.84) and good test-retest reliability (ICC = 0.86).
- Neutralizing response dependency revealed a 15% greater treatment response, suggesting improved sensitivity to change.
Conclusions:
- The Rasch-based MAL-18 is a valid and reliable measure for chronic stroke and MS upper-extremity hemiparesis.
- The shorter MAL-18 offers enhanced content and construct validity compared to the original MAL-28.
- A Rasch-based conversion table facilitates the clinical application of the MAL-18 for improved patient assessment and treatment monitoring.
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