Academic journal article British Journal of Occupational Therapy

Assessments of Upper Limb Ability Following Stroke: A Review

Academic journal article British Journal of Occupational Therapy

Assessments of Upper Limb Ability Following Stroke: A Review

Article excerpt

The aim of this paper was to review the psychometric properties and clinical utility of assessments of upper limb ability following stroke. Upper limb ability was defined as the use of the arm in meaningful activity. The database searches identified 13 assessments of upper limb ability. The inclusion criteria were (a) an evaluation of upper limb ability post-stroke, (b) a quantitative assessment yielding a numerical score, (c) able to be administered by an occupational therapist and (d) published information building on the results of a review in 2001. The assessments included were reviewed with respect to the ability measured, equipment required, evidence of reliability and validity, and advantages and disadvantages of use.

Seven assessments satisfied the inclusion criteria. These assessments have undergone varying degrees of psychometric testing as outcome measures for upper limb recovery and all demonstrate at least adequate levels of reliability and validity. There is variation in the availability of instruction manuals and time commitments for test administration. All test items are generally available and inexpensive, enabling departments to set up the assessments with minimal financial outlay.

The assessments described are regularly used in research and all demonstrate psychometric properties that suggest that they could be incorporated into clinical practice. Occupational therapists are encouraged to consider how they may include these assessments into their own clinical practice. An important step in this process may be further research into the clinical utility of these assessments.

Key words: Assessment, ability, review, stroke, upper limb.

Introduction

Stroke is the third most common cause of death and one of the leading causes of severe adult disability in the United Kingdom (Stroke Association 2008). Impaired function of the upper limb is a consequence of stroke that is commonly assessed and treated by occupational therapists during the acute and rehabilitation phases of recovery. The loss of upper limb function limits a client's ability to perform activities of daily living (Lannin 2004) and clients with stroke have identified the return of upper limb function as an important rehabilitation goal (Hawkins et al 2002). The aim of occupational therapy for clients with an upper limb difficulty is to improve the motor function of the stroke-affected side and to increase the ability of the client to engage successfully in activities of daily living (Filiatrault et al 1991).

The occupational therapist has a number of upper limb assessments to choose from in order to measure recovery following stroke. An assessment tool needs to be applicable to a wide range of abilities following stroke (Lannin 2004) and to be sensitive to the altered level of functioning characteristic of these clients (Morris et al 2001). The International Classification of Functioning, Disability and Health (World Health Organisation 2001) provides a multidimensional framework for health and disability, which is suited to the classification of outcome measures. Assessments may measure at the body function and structure level, at the activity or participation level, or along a continuum of measurement from the level of body function to participation (Salter et al 2005). An upper limb assessment performed by an occupational therapist should be distinct from the assessments of other professionals and should pertain to the goal of improving function (Okkema and Culler 1998). This paper focuses on upper limb assessments used by occupational therapists to measure recovery at the activity level. For the purposes of this paper, these assessments are defined as measuring the ability of the upper limb to perform activities of daily living.

Poole and Whitney (2001) conducted a similar review of motor function after stroke. This review included four assessments specific to the upper limb: the Frenchay Arm Test (FAT), the Action Research Arm Test (ARAT), the Functional Test for the Hemiparetic Extremity (FT) and the Arm Motor Ability Test (AMAT). …

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