The translation into Polish, cultural adaptation, and initial validation of the Action Research Arm Test in subacute stroke patients
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Updated: Jun 5, 2025
Computerized Adaptive Testing System of Functional Assessment of Stroke
Published on: January 7, 2019
Joanna Małecka1, Magdalena Goliwąs2, Katarzyna Adamczewska1
1Department of Neuromuscular Physiotherapy, Poznan University of Physical Education, Poland.
Background:
In Poland, there are limited validated outcome measures to evaluate upper extremity function in stroke patients for clinical and research use. The Action Research Arm Test (ARAT) aims to assess functional performance of the upper extremities.
Objectives:
To translate and culturally adapt the original version of ARAT into Polish, and to determine its reliability and validity.
Material And Methods:
A Polish version of ARAT (ARAT-PL) was developed using a forward-backward translation. The study then examined 60 patients with subacute stroke. Internal consistency (α), test-retest and inter-rater reliability (intra-class correlation (ICC), κ), standard error of measurement (SEM), minimal detectable change (MDC), and floor and ceiling effects were determined. The construct validity was evaluated using the method of hypothesis testing based on the results of correlations (rho) between subscale and total scores of the ARAT-PL and the upper and lower extremity section of the Fugl-Meyer Assessment (FMA-UE and FMA-LE).
Results:
The internal consistency of the total scores and subscale was excellent (α = 0.97-0.99). Test-retest and inter-rater reliability scores were almost perfect (κ = 0.85-1.0) and excellent for the total and subscale scores (ICC = 0.99-1). The SEM and MDC for the test-retest and inter-rater reliability were 0.479, 1.327 points and 0.335, 0.930 points, respectively. The ceiling effect amounted to 48%. The validity levels with respect to FMA-UE and FMA-LE were found to be high (rho ranging from 0.70 to 0.83) and moderate (rho ranging from 0.53 to 0.68), respectively.
Conclusions:
A Polish version of ARAT is a reliable and valid tool for assessing upper extremity function in subacute stroke patients in Poland. However, it appears to have a ceiling effect that limits differentiation of patients with mild upper limb impairment.
