Academic journal article New Zealand Journal of Occupational Therapy

Concurrent Validity of the Upper Limb Assessment Tool (ULAT) for Acute Neurological Patients

Academic journal article New Zealand Journal of Occupational Therapy

Concurrent Validity of the Upper Limb Assessment Tool (ULAT) for Acute Neurological Patients

Article excerpt

Within healthcare settings, patients typically receive discrete acute and subacute episodes of care following serious neurological injury and/or neurological-based disease progression. The term 'acute care' is used to refer to immediate, short-term inpatient treatment for severe illness, disease or trauma, such as acute stroke, cerebral haemorrhage or aneurysm. Confirmation of diagnosis and the provision of urgent medical/ surgical interventions are central aims of acute care, which is usually provided within a designated hospital/medical unit over a brief time period of days to weeks (Levenson, 2000; Poulos & Eagar, 2007). In contrast, subacute care is characterised by a multidisciplinary focus on functional needs and therapy goals, reflecting moderate to low patient acuity (Eagar & Innes cited in Poulos & Eagar, 2007). Subacute care provides time-limited rehabilitation and restoration, and is viewed as a precursor to either a return to independent community living or residential supported placement (nursing home care) (Levenson cited in Gray, 2002; Poulos & Eagar, 2007).

Occupational therapists practicing within acute neurosciences face many clinical challenges unique to the demands of their work environment. High patient acuity, short length of stay and constant patient throughput, all greatly impact upon occupational therapy practice. In the context of the acute neurological patient, Corben, Downie and Fielding (2011) identified that acute occupational therapists typically employ a range of non-standardised clinical techniques in their assessment of the neurological upper-limb. Significant criticisms of this subjective assessment approach have been well documented within the literature (Stapleton & Galvin, 2005; Stapleton & McBrearty, 2009). Nonetheless, a reliance on non-standardised evaluation techniques appears to have been driven in part by the perceived limitations of existing, standardised upper-limb assessments for the acute patient population, and the acute work environment. Therefore the study reported in this article explored the validity of selected upper limb assessments in acute neurological settings.

Literature review

Most standardised, neurological upper-limb assessments used by occupational therapists and physiotherapists primarily focus upon motor performance, and target the subacute stages of neurological recovery (Corben et al., 2011; Downie, 2011). Examples of these assessments include the Action Research Arm Test (Lyle, 1981), Chedoke McMaster Stroke Assessment (Barreca, Gowland, Stratford, Huijbregts, Griffiths, & Torresin,et al., 2004), Dynanometry (Bohannon, 2004), Functional Test for the Hemiplegic Upper Extremity (Fong, Ng, Chan, Chan, Ma, & Au, et al., 2004), Fugl-Meyer Upper Limb (Fugl-Meyer, Jaasko, Leyman, Olsson, & Steglind, 1975), Modified Ashworth Scale (Bohannon & Smith, 1987), Motor Assessment Scale (Carr, Shepherd, Nordholm, & Lynne, 1985), Motor Club Assessment (Ashburn, 1982), Motricity Index (Demeurisse, Demol & Robaye, 1980), Nine Hole Peg Test (Mathiowetz, Weber, Vollaqnd & Kashman, 1984), Rivermead Motor Assessment (Lincoln & Leadbitter, 1979), Trunk Control Test (Collins & Wade, 1990) and Wolf Motor Function Test (Wolf, Catlin, Ellis, Archer, Morgan, & Piacentino, 2001). With regard to service provision for acute neurological patients, a variety of impairment-level assessment criteria are also of clinical significance, such as shoulder integrity, spasticity, sensation and coordination (National Stroke Foundation, 2010). However, these aspects of the neurological upper-limb are not adequately addressed in totality by any of the above listed assessments. Rather, the reported validity of assessments varies greatly, with limited research undertaken as to their concurrent validity (refer to Table 1).

Validity refers to the degree to which an assessment measures what it purports to measure (Polgar & Thomas, 2008), and is central to an assessment's accuracy in detecting change in defined characteristics of patient function, and the subsequent correct interpretation of test results (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 1999). …

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