Activity Measure for Postacute Care, Computer-Adapted Test Versus "6-Clicks"; Do They Agree in Individuals...

Area of Science:

• Rehabilitation Medicine
• Neurology
• Biostatistics

Background:

• Accurate functional assessment is crucial for stroke rehabilitation.
• The Activity Measure for Postacute Care (AM-PAC) Computer Adaptive Test (CAT) and "6-Clicks" are common tools for measuring functional status.
• Understanding agreement between these tools is vital for consistent patient evaluation.

Purpose of the Study:

• To evaluate the agreement between the AM-PAC CAT and "6-Clicks" short forms.
• To assess agreement across basic mobility (BM), daily activity (DA), and applied cognition (AC) domains.
• To identify potential systematic biases in stroke patient assessments.

Main Methods:

• Secondary analysis of a prospective, longitudinal cohort study.
• Included 137 adult individuals post-ischemic stroke during acute hospitalization.
• Assessed agreement using intraclass correlation coefficients, weighted κ statistics, equivalence tests, and Bland-Altman plots.

Main Results:

• Intraclass correlation coefficients indicated poor agreement (BM=0.58, DA=0.64, AC=0.48).
• Weighted κ values showed good agreement for BM (0.74) and DA (0.63), moderate for AC (0.53).
• Bland-Altman plots revealed systematic bias, with "6-Clicks" overestimating scores compared to CAT in BM and DA.

Conclusions:

• Agreement between AM-PAC CAT and "6-Clicks" is poor to moderate across all three domains.
• Systematic bias exists at higher and lower score ranges, particularly in basic mobility and daily activity.
• Findings highlight potential discrepancies in functional status assessment for post-stroke individuals.