Reliability and validity of the 15-item Action Research Arm Test with a clinically-informed decision rule

Area of Science:

• Rehabilitation Medicine
• Neuroscience
• Clinical Assessment

Background:

• The 19-item Action Research Arm Test (ARAT) is widely used for assessing upper limb function after stroke.
• A time-efficient 15-item ARAT version utilizing a decision rule has been proposed.
• Formal evaluation of the reliability and validity of this decision rule and optimal item administration direction is lacking.

Purpose of the Study:

• To evaluate the reliability and criterion-related validity of a 15-item ARAT with a decision rule.
• To assess the impact of a task direction protocol based on Brunnstrom Recovery Stages on the 15-item ARAT.
• To determine if the proposed 15-item ARAT decision rule maintains measurement properties compared to the standard 19-item version.

Main Methods:

• A cross-sectional study involving 30 patients with post-stroke hemiparesis.
• Assessment using the 19-item ARAT and the Fugl-Meyer Assessment (FMA).
• Reliability assessed via intraclass correlation coefficients (ICC) and weighted kappa (κ); criterion-related validity assessed via Spearman's rho (ρ).

Main Results:

• The decision rule reduced the number of administered items by 49.8% (450 to 226).
• High reliability was observed (ICC = 0.997), with strong item-level agreement (κ = 0.88-1.00).
• Strong correlations were found with the FMA (ρ = 0.72) and the 19-item ARAT (ρ = 0.96).

Conclusions:

• The 15-item ARAT with a decision rule significantly enhances testing efficiency.
• This revised ARAT protocol demonstrates high reliability and criterion-related validity.
• The decision rule allows for a shorter assessment without compromising the measurement integrity of the ARAT.