(Stroke. 2001;32:1627.)
© 2001 American Heart Association, Inc.
Original Contributions |
The ABILHAND Questionnaire as a Measure of Manual Ability in Chronic Stroke Patients
Rasch-Based Validation and Relationship to Upper Limb Impairment
From the Rehabilitation and Physical Medicine Unit, Université catholique de Louvain, Brussels, Belgium (M.P., C.A., J-L.T.); and the Salvatore Maugeri Foundation, IRCCS, the Unità di Ricerca, Valutazione Funzionale e Verifica di Qualità in Riabilitazione (L.T.), and Divisione di Recupero e Rieducazione Funzionale (L.T., A.Z.), Pavia, Italy.
 |
Abstract |
|---|
 Top Abstract IntroductionSubjects and MethodsResultsDiscussionReferences |
|---|
Background and Purpose—Chronic hemiparetic patients often retain the ability to manage activities requiring both hands, either through the use of the affected arm or compensation with the unaffected limb. A measure of this overall ability was developed by adapting and validating the ABILHAND questionnaire through the Rasch measurement model. ABILHAND measures the patient’s perceived difficulty in performing everyday manual activities.
Methods—One hundred three chronic (>6 months) stroke outpatients (62% men; mean age, 63 years) were assessed (74 in Belgium, 29 in Italy). They lived at home and walked independently and were screened for the absence of major cognitive deficits (dementia, aphasia, hemineglect). The patients were administered the ABILHAND questionnaire, the Brunnström upper limb motricity test, the box-and-block manual dexterity test, the Semmes-Weinstein tactile sensation test, and the Geriatric Depression Scale. The brain lesion type and site were recorded. ABILHAND results were analyzed with the use of Winsteps Rasch software.
Results—The Rasch refinement of ABILHAND led to a change from the original unimanual and bimanual 56-item, 4-level scale to a bimanual 23-item, 3-level scale. The resulting ability scale had sufficient sensitivity to be clinically useful. Rasch reliability was 0.90, and the item-difficulty hierarchy was stable across demographic and clinical subgroups. Grip strength, motricity, dexterity, and depression were significantly correlated with the ABILHAND measures.
Conclusions—The ABILHAND questionnaire results in a valid person-centered measure of manual ability in everyday activities. The stability of the item-difficulty hierarchy across different patient classes further supports the clinical application of the scale.
Key Words: arm • disability evaluation • rehabilitation • stroke
|
Introduction |
|---|
|
TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
|---|
Poststroke hemiplegia is one of the most prevalent forms of motor disability, affecting approximately 1% of the population.1 Although most current stroke survivors achieve an autonomous form of gait, a satisfactory recovery (if any) of the affected upper limb function is much more rare.
Although several tests are available2 3 4 for measuring upper limb function in terms of grip strength, dexterity, sensation, and performance in standardized manipulative tasks, the measurements are all made at the focal impairment level.5 The actual disability, however, is far from linearly related to the underlying impairments.6 It depends on complex interactions between upper limb function and compensatory behaviors of the person, such as using the unaffected limb or dividing complex movements into simpler ones. Moreover, the learning of new motor processes is influenced by the subject’s motivational and emotional status, which is likely to be impaired by stroke.7
Manual ability may be defined as the capacity to manage daily activities requiring the use of the upper limbs, whatever the strategies involved. Therefore, it should be measured per se and not simply inferred from focal impairments. Since it is a behavior, manual ability belongs to the domain of latent variables concealed within the person, such as pain, depression, and intelligence. The "amount" of manual ability can be inferred from observed activities and/or a patient’s perceived difficulty8 in performing activities, as determined by questionnaires. A linear measure of manual ability, however, can only be properly estimated from raw scores according to measurement models,9 the most promising being the Rasch model.10 Provided that the behavioral data fit the model requirements, the manual ability measure for each patient is estimated via the Rasch model on a measurement "ruler" defined by the difficulty of the manual activities. Once the scale is established, it is necessary to verify that the hierarchy of activity difficulties is the same for patients with different impairments.
The primary objective in this study was to adapt and validate the ABILHAND11 scale for chronic stroke patients. The stability of item difficulty across relevant clinical subgroups was also tested. A secondary objective was the clarification of the relation between the neuromotor deficits and the resulting ABILHAND measures.
|
Subjects and Methods |
|---|
|
TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
|---|
Study Design
Five main steps were followed to achieve the study goals. First, patients were asked to answer the original ABILHAND items on a scale of 4 levels. Second, internal validity was established with the Rasch model through selection of items and response levels; this procedure also allowed the perceived difficulty of the items to be determined on a linear scale. Third, stability of item difficulty was verified by comparing 12 different groupings of the sample pool, such as male versus female and right versus left stroke. Fourth, the ranking of item difficulty was compared with expert opinions about the involvement of the affected hand in each activity. Fifth, traditional clinical assessments were used to validate the ABILHAND manual ability measurements.
Subjects: Chronic Stroke Patients
The study was authorized by the ethics committees of
the Université catholique de Louvain, Faculty of Medicine in
Brussels, Belgium, and the Salvatore Maugeri Foundation in Pavia,
Italy. The World Health Organization
definition12 was adopted for
selecting patients. This definition includes subarachnoid
hemorrhage but excludes transient ischemic attacks with
symptoms lasting <24 hours, subdural hemorrhage, and
hemorrhage or infarction caused by infection or
tumor.
Given that the data come from patients’ perceptions, the
study was restricted to patients who performed the listed manual
activities in a domestic environment and were able to report their
perceived difficulty. Patients had to meet the following criteria: have
unilateral hemiplegia/paresis subsequent to a stroke that had occurred
at least 6 months earlier; live at home and be independent in a
domestic environment (
5 of 7 on the toilet transfer and locomotion
items of the Functional Independence
Measure13 ); show no major
visual acuity deficit (4 of 5 on the visual item of the Incapacity
Status Scale14 ); show no
major visual neglect (26 of 35 on the Bell
Test15 ); show no major
cognitive deficit (24 of 30 on the Mini-Mental State
Examination16 ); show no
major sign of aphasia (6 of 6 on the Breviario di patologia della
comunicazione test17 ); have
no upper limb sensorimotor deficits other than those related to the
stroke; and be a native French or Italian speaker.
Two hundred patients from Belgium and 100 patients from Italy fulfilling the inclusion criteria were mailed a standard letter presenting the research and were contacted by telephone a few days later to verify their eligibility and agreement to participate in the study. Of the 300 potential patients, 170 were not evaluated because they had either died (n=27), could not be contacted by telephone (n=88), were noted to be ineligible for clinical reasons after the telephone interview (n=35), or refused to participate (n=20).
Testing Procedures
The 130 remaining patients were tested by one of the
investigators in a clinical laboratory or at home. Functional tests
were performed in 1 session lasting 60 to 90 minutes. After the
evaluation, 27 patients were excluded because they failed to meet the
eligibility criteria, providing a final sample of 103 patients (74 in
Belgium and 29 in Italy). A summary of the final sample is provided in
Table 1
.
|
Clinical Assessment
Cerebral lesion territories were determined on the
basis of a review of medical charts and neuroimaging (when available)
according to Damasio.18
Middle cerebral artery infarcts were subclassified according to Moulin
et
al.19
Handedness
The patient’s prestroke handedness was assessed
through the Edinburgh
Inventory.20
Depression
Depression was assessed with the Geriatric Depression
Scale21 (GDS). The GDS score
was compensated for missing values by forcing each missing score to the
average score computed on the answered items.
Manual Ability
Manual ability was assessed with
ABILHAND.11 ABILHAND is an
inventory of 56 manual activities that the patient was originally asked
to judge on a 4-level scale: 0 (impossible), 1 (very difficult), 2
(difficult), and 3 (easy). The test explores both unimanual and
bimanual activities done without other human or technical help. For
each question the patient provided his/her feeling of difficulty
irrespective of the limb(s) actually used to do the activity.
Activities not attempted in the last 3 months were not scored and were
encoded as missing responses.
Upper Limb Assessment
Upper limb motricity was assessed with the upper limb
subscale of the Brunnström motor
assessment.22 Grip strength
was measured with a Jamar dynamometer according to the procedure
described by Mathiowetz et
al.2 Tactile sensitivity on
the pulp of the second finger was determined with the Semmes-Weinstein
aesthesiometer according to the procedure described by
Bell-Krotoski.4 Manual
dexterity was evaluated with the box-and-block
test.3 Grip strength, tactile
sensitivity, and manual dexterity were evaluated on both hands,
starting with the unaffected one.
Data Analysis
Measuring Manual Ability Through the Rasch
Model
The ABILHAND questionnaire was analyzed with
the Winsteps Rasch analysis computer
program.23 For all items,
the response categories were analyzed according to the rating
scale model.24 The model
requires, within a probabilistic framework, that the patient’s
response to an item depends solely on the ability of the patient and
the difficulty of the response categories (computed as the sum of the
item difficulty and the threshold difficulties that separate each pair
of successive responses). On the basis of the estimated ability of the
patient and difficulty of the item, the expected response of a subject
to an item can be computed by the model. The similarity between the
observed and expected responses to any item is reported by the
software, through 2 fit mean-square statistics: (1) the
outlier-sensitive fit statistic (OUTFIT) and (2) the
information-weighted fit statistic
(INFIT).24 The point-measure
correlation coefficient (RPM) indicates the coherence of each item
within the whole questionnaire. It is computed as the correlation
coefficient between all patients’ responses to an item and their
measures on the overall questionnaire. These indicators were used to
refine the original ABILHAND scale specifically for chronic stroke
patients.
Determining the Stability of the Scale Through
Differential Item Functioning Tests
Once satisfactory metric properties were achieved,
the invariance in the item difficulty hierarchy among patient subgroups
(eg, men versus women) was
tested.23 25
Twelve differential item functioning (DIF) subgroups were formed on the
basis of the following criteria: (1) sex (male versus female); (2)
country (Belgium versus Italy); (3) age (<60 versus 60 years); (4)
affected side (dominant versus nondominant); (5) delay since
cerebrovascular accident (CVA) (<2 versus 2 years); (6) level of
depression (<10 versus 10, where 10 is the upper limit of the normal
range according to Brink et
al21 ; (7) dexterity of the
unaffected upper limb (less versus more dexterity, split on the median
score); (8) manual ability (less versus more able, split on the median
manual ability measure); (9, 10, 11) grip strength, dexterity,
sensitivity of the affected upper limb (less versus more deficit,
computed as the difference between affected and unaffected side, split
on the median difference); and (12) motricity of the affected upper
limb (less versus more motricity, split on the median motricity
score).
Content Validation
To validate the difficulty hierarchy of the bimanual
activities, 4 occupational therapists were independently asked to
classify each item according to the involvement of the affected hand in
the activity. All bimanual activities were classified as either (1) not
requiring the affected limb, if broken down into several unimanual
sequences (A); (2) requiring the affected limb to stabilize an object,
but not involving any finger on the affected side (B); or (3) requiring
precision grip, grip strength, dexterity, or any digital activity from
the affected side (C).
Standardizing Measures of Upper Limb
Impairment
Grip strength, manual dexterity, and tactile
sensitivity scores were
z-transformed with respect to
normative data available in the
literature3 26 or
unpublished norms established in our laboratory (for sensitivity). This
procedure accounts for sex, age, and handedness and allows the results
of all tests, on either limb, to be expressed on a common scale. A
z score range between -2 and
2 was considered not significantly different from
normal.
Construct Validation: Comparison of ABILHAND
Measures Across Demographic and Clinical Subgroups
The relationship between ABILHAND and demographic and
clinical indicators was tested with either univariate ANOVA
(for nominal predictors) or correlation coefficients (for continuous
predictors). The number of records available precluded a formal
multivariate approach, although an exploratory
classification was attempted by relating ABILHAND measures to
combinations of impairments on the affected side. Patients with
z scores <-1 on the affected
side were classified as poor performers for grip strength, manual
dexterity, or tactile sensitivity. Patients with Brunnström test
scores <75% of full scale (ie, 67 of 90) were classified as poor
performers for upper limb motricity. The effects of combinations of
impairments were tested with
ANOVA.
|
Results |
|---|
|
TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
|---|
ABILHAND Refinements Made Specifically for Chronic Stroke Patients
Patients were unable to discriminate 4 levels of difficulty in manual activities. Although the 4 possible answers (impossible, very difficult, difficult, and easy) were shown to define increasing levels of difficulty, the second answer was too rarely observed for patients presenting the ability to select this category. This indicated that the 2 intermediate categories were not distinct enough to be differentiated by the patients.27 Consequently, the 4 original categories were rescored as follows: 0 (impossible), 1 (any difficulty), and 2 (easy).
Analysis of the original 56 ABILHAND items showed that they could be divided into 2 groups: those usually realized with 1 hand (30 items) and those usually realized with 2 (26 items). Not only were unimanual activities the easiest for chronic stroke patients, but they were also the least related (RPM <0.50) to the common manual ability construct (see Discussion). Therefore, only the bimanual activities were retained in the ABILHAND calibration proposed specifically for chronic stroke patients. Two "alternate unimanual" activities, cutting and filing nails, were also kept because they require the skillful use of the affected hand. Three additional items were excluded because they were not commonly practiced across the calibrating sample. All together, the calibration proposed for chronic stroke patients was established on 23 usually bimanual items.
The Final Measure of Manual Ability
Description of ABILHAND
The definition and use of the linear ABILHAND scale is
shown in
Figure 1. The distribution of patient measures is
presented in the top panel of the figure, ranging approximately
from -3.5 to 6 logits. This range indicates that the odds of success
(the pass/fail ratio) of the most able patient for any given item are
13 360 times (e9.5/1) greater than for the
least able patient; this clearly illustrates the wide variety of manual
ability levels encountered in this study. This measure of manual
ability was obtained by converting the raw score on the 23
questionnaire items into linear logit units, as shown by the
relationship presented in the bottom of the figure. The
nonlinear relation between the raw score and ABILHAND measures results
in greater ability discrimination in the central scoring range. At any
given ability level, a 1-logit difference between 2 patients indicates
that their odds of successful achievement of any activity are 2.7:1
(e1/1), 2 logits results in 7.4:1 odds, and
3 logits results in >20:1 odds.
|
As shown in the item map
(Figure 1
, middle panel), the greater the difference between
a patient’s ability and the average difficulty for any given item, the
more likely is a higher score. For instance, being able to easily
spread butter on a slice of bread requires a measure of at least 0.73
logits, while any patient less able than -2.16 logits would be
expected to report this activity as impossible. As measured by
ABILHAND, chronic stroke patients report a relatively high manual
ability. Patients with measures >0.28 logits (75 of 103) report that
they can successfully perform all the listed activities, although with
some difficulty on the most difficult ones. Furthermore, patients with
measures >3.17 logits (26 of 103) report that they can perform all the
listed activities easily. This suggests that the scale has the
potential to measure more severely disabled
patients.
Differential Item Functioning
The difficulty hierarchy of ABILHAND appears to be
uniformly perceived by chronic stroke patients. The patients were
divided into 2 groups on the basis of 12 different criteria such as sex
or age, and the 2 groups’ perceptions of each item’s difficulty are
plotted one against the other in the 12 panels of
Figure 2. Since the majority of items lie within the
95% CI of the identity line, the perceptions appear to be group
independent. There are exceptions; for instance, "shelling hazel
nuts" appears to be more difficult for women than for men, while
"tearing open a pack of chips" appears to be more difficult for
patients older than 60 years than for younger
patients.
|
Metric Properties of ABILHAND
The measure of perceived difficulty for the 23 retained
bimanual items is presented in
Table 2. The items are sorted, from top to bottom, in
order of decreasing difficulty (range, 1.72 to -2.18 logits), with
higher logit values indicating more difficult activities. The table
also gives the standard error of the item difficulty estimates.
Overall, the 23 items fit the Rasch model, according to the acceptable
range of fit statistics proposed by Smith et
al.28 Therefore, the 23
items define a common continuum of manual ability. All RPM are
positive, indicating that all items are coherent with the overall
questionnaire and contribute to the measurement of manual
ability.
|
The least measurable difference25 (the difference in linear measure obtained by a unit increase in raw score) is equal to 0.13 logits in the center of the scale. This indicates that in the central range, the scale resolution is sufficient to differentiate the ability of 2 subjects if one has 50% probability to pass a given item and the other 47%. The overall scale precision is summarized by a good person separation reliability of 0.90 in this sample. It appears sufficient to discriminate across patients and, presumably, to capture even subtle functional changes with time.
Content Validation
The opinions of the 4 experts concerning limb
involvement in each activity were consistent. The most
frequently reported opinion is presented for each item in the
last column in
Table 2. It appears that the activities that define the
more difficult levels of the scale also tend to require a higher
involvement of the affected limb (C), while the easier activities can
be achieved in a movement sequence that does not require the affected
limb (A).
Construct Validation
Description of Upper Limb Impairments
Both grip strength and tactile sensitivity were in the
normal range on the unaffected limb, although manual dexterity was
significantly impaired in 47 of the 103 patients
(Table 3). On the affected limb, the patients showed a
wide variety of motricity impairment. For all impairments on the
affected side, the scores were more spread than on the unaffected side,
reinforcing the impairment heterogeneity observed in
motricity. A Wilcoxon signed rank test showed a significant
difference between the affected and unaffected side in both grip
strength and manual dexterity.
|
Relationship of ABILHAND Measures to Other
Clinical Indicators
The effects of demographic and clinical variables
on ABILHAND measures are presented in
Table 4. Through univariate tests, no
significant differences in ABILHAND measures were observed across
demographic indexes (country, sex, and age). Tactile sensitivity in
either upper limb, the side affected, or the cerebral lesion site was
not significantly related to ABILHAND measures. Grip strength and
manual dexterity were slightly but significantly related to ABILHAND
measures in the unaffected limb. ABILHAND measures were significantly
related both to individual motor impairments and to cumulative motor
impairments on the affected side. Depression was also significantly
related to ABILHAND measures.
|
Influence of Interacting Impairments on
ABILHAND Measures
The effect of combined motor impairments on ABILHAND
measures is illustrated in
Figure 3. In the entire sample, the 2 patients without
motor impairments on the affected side had the highest manual ability
(top row). Twenty-five patients with poor manual dexterity
(z score <-1) and normal
performance on other upper limb functions presented
slightly reduced ABILHAND measures (second row). From top to bottom,
more complex observed combinations of impairments on the affected side
led to higher disability in manual activities. The 51 patients with
poor performance in dexterity, grip strength, and motricity on
the affected upper limb (bottom row) had a median ABILHAND measure of
approximately 0 logits, corresponding to the average item difficulty.
Tactile sensitivity was found to have little interaction with the other
motor impairments on the affected side, since if it were included in
the groups shown in
Figure 3, it had no effect on their
hierarchy.
|
|
Discussion |
|---|
|
TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
|---|
Patient’s Reported Manual Ability in Chronic Stroke
The primary focus of this study was the validation of ABILHAND as a measure of manual ability in chronic stroke patients. The original questionnaire included both unimanual and bimanual activities of daily life needing manual skills for successful completion.11 Analysis of the original questionnaire showed that the unimanual activities were too easy to be able to discriminate manual ability in chronic stroke patients; the patients reported they could fulfill the activities using the unaffected limb, whether dominant or nondominant. In contrast, the bimanual (or alternate unimanual) activities were shown to be more demanding and capable of discriminating the patients’ manual ability. These observations were reinforced by the low coherence between the scores for the unimanual activities and the other responses in the questionnaire (RPM ranging from 0.10 to 0.49). Moreover, a significant difference in INFIT (P<0.001, t test) revealed a subtle but systematic difference in the patients’ perceived difficulty in unimanual versus bimanual activities. ABILHAND was clearly able to measure a patient’s adaptation, several months after stroke, to managing bimanual activities that by definition require the use of the affected hand.
According to the aforementioned considerations, only the bimanual activities were retained for the validation of ABILHAND in chronic stroke. The fit statistics reported in the final analysis indicate that, overall, bimanual activities are tightly focused on the recovery of manual ability in chronic stroke. This coherence of ABILHAND was obtained by asking the patient’s perception of an activity’s difficulty, independent of the limb used or strategy adopted. Only the items "shelling hazel nuts" (item i), "tearing open a pack of chips" (item l), and "buttoning up a shirt" (item m) showed inflated fit statistics, indicating a minor inconsistency in the difficulty experienced by patients of different ability. This inconsistency may be because these activities can be done either bimanually or unimanually. Nevertheless, the observed item hierarchy in our sample makes clinical sense because activities requiring a higher bimanual involvement were estimated to be more difficult. This hierarchy appears to match the learning-based pattern of motor recovery after stroke and suggests that rehabilitation in chronic stages should focus on learning adaptive processes either through the more difficult bimanual activities or through the forced use of the affected limb.29
The observed stability in the item hierarchy across the different groups of patients supports the clinical application of the ABILHAND scale as a measure of manual ability in chronic stroke patients. However, since this validation study investigated a highly selected sample of stroke patients, further research is needed to verify that the item hierarchy remains stable both among a more general population of stroke patients and along the process of rehabilitation.
A potential limitation of the ABILHAND scale lies in the subjective nature of patients’ reports, which restricts its application to patients without severe cognitive deficits. In addition, self-reported scores are prone to overestimation or underestimation of actual performances, depending on either motivation and/or cognitive skills. Nevertheless, self-estimated measures of disability have many advantages. First, they explore activities that are very meaningful to the patient in real-life contexts yet very hard to reproduce in a laboratory environment. Second, the self-estimated measures can capture a sort of weighted average of the performance across long time periods, which is not the case for most observational tests. This "average" has more chance of representing the overall impact of the disability on the burden of care required and the patient’s quality of life.30
Relationship Between ABILHAND and Clinical
Presentation
The analysis of the relationship between
neuromotor performance and the resulting ABILHAND measure
appears not only as a form of validation of ABILHAND but also as a
clinical end point in itself. The upper limb impairments measured in
this study confirm previous reports of functional deficits in chronic
stroke patients on both the
unaffected31 32
and the affected sides.33
This study confirms that grip strength and manual dexterity were
significantly impaired on the affected side. On the unaffected side,
only manual dexterity appeared to be significantly impaired
(z score <-2) in 47 of 103
patients. However, both dexterity and grip strength were significantly
correlated to manual ability on the unaffected side. The impact of mild
motor impairments of the unaffected limb on manual ability, anticipated
in other
studies,31 32 34
fits very well with the required bimanual involvement of the ABILHAND
activities.
The lack of a significant relationship between the side (dominant/nondominant) affected and manual ability also confirms previous reports.31 35 No significant changes in ABILHAND measures were found as a function of the lesion location, width, and depth. This finding can be explained by (1) the chronicity of the lesion, allowing time for neural repair, either intrinsic or adaptive; (2) the exclusion of subjects with major cognitive deficits36 ; and (3) the small number of cases representing each different type of brain damage, resulting in a low power to detect any difference. Nevertheless, the lack of a strong relationship between manual disability and specific brain lesions argues in favor of ABILHAND being focused on the behavioral learning of new motor processes through compensatory strategies, irrespective of the underlying impairments. Further evidence can be found in the insignificant impact of the delay since the CVA or the end of physiotherapy. This may also be explained by the selection criteria restricting participation in this study to chronic stroke survivors living at home. Hence, the patients investigated here had experience performing most of the listed activities and had already developed, at least to some degree, new motor strategies to independently cope with their domestic environment; this would not be the situation in acute cases.
The most influential determinants of ABILHAND measures in this study are depression and motor deficits (particularly on the affected side). While manual ability can profit from any compensation strategy, it will suffer from any failure in the underlying neuromotor functions and/or in the patient’s motivation to compensate for the failure itself. Moreover, depression might affect the reported ABILHAND measure either through a patient’s motivation or self-judgment of the reported difficulty. The relationship between manual ability and brain lesions, motor impairments, cognitive impairments, and age certainly needs further investigation. Because of the limited number of cases involved in this study, a multivariate analysis could not be validly attempted, yet a clear tendency toward a cumulative impact of motor impairments on ABILHAND measures was detected. Some recent studies have reported a weak relationship between sensory motor impairment and manual activities of daily life.31 37 38
ABILHAND was not tested for sensitivity to a change in patients’ status, such as before and after rehabilitation. The stability in item hierarchy across different patient subgroups suggests that the hierarchy very well may also be maintained across time and treatment. If the hierarchy is also maintained along time, this scale will provide both a valid outcome measure and a detailed guideline for goal setting in treatment planning, complementary to the available measures of focal impairments.
|
Acknowledgments |
|---|
The authors are grateful to Drs André Peeters, Elisabeth Kolanowski, and Philippe Hanson, who allowed them to evaluate their patients, and to Dr Norman Heglund for reviewing an earlier version of the manuscript.
|
Footnotes |
|---|
Reprint requests to Professor J-L. Thonnard, Université catholique de Louvain, Unité de réadaptation, Tour Pasteur (5375), Avenue Mounier 53, 1200 Bruxelles, Belgium.
Received October 30, 2000; revision received March 16, 2001; accepted March 22, 2001.
|
References |
|---|
|
TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
|---|
1. Hankey GJ. Stroke: how large a public health problem, and how can the neurologist help? Arch Neurol. 1999;56:748–754.
2. Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of pinch and grip strength evaluations. J Hand Surg. 1984;9A:222–226.
3. Mathiowetz V, Volland G, Kashman N, Weber K. Adult norms for the box and block test of manual dexterity. Am J Occup Ther. 1985;39:386–391.[Medline] [Order article via Infotrieve]
4. Bell-Krotoski JA. Light touch–deep pressure testing using Semmes-Weinstein monofilaments. In: Hunter JM, Schneider LH, Mackin EJ, Callahan AD, eds. Rehabilitation of the Hand: Surgery and Therapy. St Louis, Mo: Mosby Co; 1990:585–593.
5. World Health Organization. International Classification of Impairments, Disabilities, and Handicaps. Geneva, Switzerland: WHO; 1980.
6. Roth EJ, Heinemann AW, Lovell LL, Harvey RL, McGuire JR, Diaz S. Impairment and disability: their relation during stroke rehabilitation. Arch Phys Med Rehabil. 1998;79:329–335.[Medline] [Order article via Infotrieve]
7.
Wade DT.
Epidemiology of disabling neurological disease:
how and why does disability occur? J
Neurol Neurosurg Psychiatry. 1997;63:S11–S18.
8.
Grimby G, Andren E,
Daving Y, Wright B. Dependence and perceived difficulty in daily
activities in community-living stroke survivors 2 years after stroke: a
study of instrumental structures.
Stroke. 1998;29:1843–1849.
9. Wright BD, Linacre JM. Observations are always ordinal; measurement, however, must be interval. Arch Phys Med Rehabil. 1989;70:857–860.[Medline] [Order article via Infotrieve]
10. Rasch G. Probabilistic Models for Some Intelligence and Attainment Tests. Chicago, Ill: Mesa Press; 1980.
11. Penta M, Thonnard J-L, Tesio L. ABILHAND: a Rasch-built measure of manual ability. Arch Phys Med Rehabil. 1998;79:1038–1042.[Medline] [Order article via Infotrieve]
12. World Health Organization. Control of Stroke in the Community: Methodological Considerations and Protocol of WHO Stroke Register. Geneva, Switzerland: WHO; 1973.
13. Guide for the Uniform Data Set for Medical Rehabilitation (Including the FIMTM Instrument), version 5.1. Buffalo, NY: University of Buffalo; 1997.
14. Kurtzke JF. Disability rating scales in multiple sclerosis. Ann NY Acad Sci. 1984;436:347–360.[Medline] [Order article via Infotrieve]
15. Gauthier L, Dehaut F, Joanette Y. The Bells test: a quantitative and qualitative test for visual neglect. Int J Clin Neuropsychol. 1989;11:49–54.
16. Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198.[Medline] [Order article via Infotrieve]
17. Schindler O. Breviario di patologia della comunicazione (Handbook of Communication Disorders). Turin, Italy: Omega Edizioni; 1998.
18.
Damasio H. A
computed tomographic guide to the identification of cerebral vascular
territories. Arch Neurol. 1983;40:138–142.
19.
Moulin T, Cattin
F, Crépin-Leblond T, Tatu L, Chavot D, Piotin M, Viel JF, Rumbach L,
Bonneville JF. Early CT signs in acute middle cerebral artery
infarction: predictive value for subsequent infarct locations and
outcome. Neurology. 1996;47:366–375.
20. Oldfield RC. The assessment and analysis of handedness: the Edinburgh Inventory. Neuropsychologia. 1971;9:97–113.[Medline] [Order article via Infotrieve]
21. Brink TL, Yesavage JA, Lum O, Heersema PH, Adey M, Rose TL. Screening tests for geriatric depression. Clin Gerontol. 1982;1:37–43.
22. Sultana R. La méthode de Brunnström: Bilan et techniques dans la rééducation des hémiplégiques et des traumatisés crâniens. Paris, France: Masson; 1994.
23. Linacre JM, Wright BD. A User’s Guide to Winsteps: Rasch-Model Computer Program. Chicago, Ill: Mesa Press; 1998.
24. Wright BD, Masters GN. Rating Scale Analysis. Chicago, Ill: Mesa Press; 1982.
25. Wright BD, Stone MH. Best Test Design. Chicago, Ill: Mesa Press; 1979.
26. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66:69–74.[Medline] [Order article via Infotrieve]
27. Andrich D. Category ordering and their utility. Rasch Meas Transact. 1996;9:464–465.
28. Smith RM, Schumacker RE, Bush MJ. Using item mean squares to evaluate fit to the Rasch model. J Outcome Meas. 1998;2:66–78.[Medline] [Order article via Infotrieve]
29.
Van der Lee JH,
Wagenaar RC, Lankhorst GJ, Vogelaar TW, Devillé WL, Bouter LM. Forced
use of the upper extremity in chronic stroke patients: results from a
single-blind randomized clinical trial.
Stroke. 1999;30:2369–2375.
30. Lusardi MM, Smith EV. Development of a scale to assess concern about falling and applications to treatment programs. J Outcome Meas. 1997;1:34–55.[Medline] [Order article via Infotrieve]
31.
Desrosiers J,
Bourbonnais D, Bravo G, Roy P-M, Guay M. Performance of the
"unaffected" upper extremity of elderly stroke patients.
Stroke. 1996;27:1564–1570.
32.
Sunderland A.
Recovery of ipsilateral dexterity after stroke.
Stroke. 2000;31:430–433.
33.
Boissy P,
Bourbonnais D, Carlotti MM, Gravel D, Arsenault BA. Maximal grip force
in chronic stroke subjects and its relationship to global upper
extremity function. Clin Rehab. 1999;13:354–362.
34. Yelnik A, Bonan I, Debray M, Lo E, Gelbert F, Bussel B. Changes in the execution of a complex manual task after ipsilateral ischemic cerebral hemispheric stroke. Arch Phys Med Rehabil. 1996;77:806–810.[Medline] [Order article via Infotrieve]
35. Bernspang B, Fisher AG. Differences between persons with right or left cerebral vascular accident on the assessment of motor and process skills. Arch Phys Med Rehabil. 1995;76:1144–1151.[Medline] [Order article via Infotrieve]
36.
Sunderland A,
Bowers M, Sluman S-M, Wilcock DJ, Ardron ME. Impaired dexterity of the
ipsilateral hand after stroke and the relationship to cognitive
deficit. Stroke. 1999;30:949–955.
37. Sonoda N, Chino N, Domen K, Saitoh E. Changes in impairment and disability from the third to the sixth month after stroke and its relationship evaluated by an artificial neural network. Am J Phys Med Rehabil. 1997;76:395–400.[Medline] [Order article via Infotrieve]
38. Kopp B, Kunkel A, Flor H, Platz T, Rose U, Mauritz K-H, Gresser K, McCulloch KL, Taub E. The arm motor ability test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living. Arch Phys Med Rehabil. 1997;78:615–620. [Medline] [Order article via Infotrieve]
This article has been cited by other articles:
 |
|
 |
|
  G. D. Caty, C. Detrembleur, C. Bleyenheuft, T. Deltombe, and T. M. Lejeune Effect of Upper Limb Botulinum Toxin Injections on Impairment, Activity, Participation, and Quality of Life Among Stroke Patients Stroke, July 1, 2009; 40(7): 2589 - 2591. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Durez, V. Fraselle, F. Houssiau, J.-L. Thonnard, H. Nielens, and M. Penta Validation of the ABILHAND questionnaire as a measure of manual ability in patients with rheumatoid arthritis Ann Rheum Dis, August 1, 2007; 66(8): 1098 - 1105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. C. CHEN, C. V. GRANGER, C. A. PEIMER, O. J. MOY, and S. WALD Manual Ability Measure (MAM-16): A Preliminary Report on a New Patient-Centred and Task-Oriented Outcome Measure of Hand Function J Hand Surg Eur Vol., April 1, 2005; 30(2): 207 - 216. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Arnould, M. Penta, A. Renders, and J.-L. Thonnard ABILHAND-Kids: A measure of manual ability in children with cerebral palsy Neurology, September 28, 2004; 63(6): 1045 - 1052. [Abstract] [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||