Development of a classification scale for arm use following stroke

Introduction and Purpose Understanding upper extremity functional recovery following stroke requires knowledge of how individuals use their upper extremity in the home and community settings. Currently, there are no measures that provide a rich description about the types of activities and manner in which they are performed by the affected upper extremity. This study aimed to develop and validate a classification scale that captures UE use following stroke. Objectives 1. To conduct a systematic review of existing research on the ability of UE function and UE use measures following stroke to capture important, observed and detectable change. 2. To develop a new classification tool, Rating of Everyday Arm-use in the Community and Home (REACH) scale, that captures UE use and to assess the interrater reliability and validity of the new tool. Methods Design: This study used multiple methods to achieve the stated objectives. A systematic review methodology that reviewed 68 articles covering 14 measures was employed. Development of the REACH scale utilized focus groups to acquire client, clinician, and caregiver perspectives. Evaluation of interrater reliability involved a test-retest design with different raters. Hypothesis testing was used to assess the validity of the REACH scale. Participants: Focus groups included clinicians (n=13), participants with stroke (n=16), and caregivers (n=4). Individuals with stroke living in the community participated in the evaluation of the REACH scale (n=96). Measures: Responsiveness indices were extracted and calculated from the included articles for the systematic review. The following measures were used to evaluate the REACH scale: Motor Activity Log, activity counts captured by accelerometers, Action Research Arm Test, Stroke Impact Scale – hand subscale, Chedoke-McMaster Stroke Assessment (Arm Recovery, Hand Recovery, and Shoulder pain scales). Results The REACH scale, informed by literature and user consultation, takes 5 minutes to administer. The intraclass correlation coefficient and weighted kappa for interrater reliability was 0.96 and 0.91 respectively. Strong relationships were observed between the REACH scores and external measures of UE use, UE function and UE impairment (ρ=0.91-0.94). Conclusions The REACH scale provides an accessible and efficient tool for measuring UE use following stroke.Medicine, Faculty ofGraduat