Background: Functional limitation of the upper extremities is common in patients with stroke. An upper-extremity measure with sound psychometric properties is indispensable for clinical and research use.Objective: The purpose of this study was to compare the psychometric properties of 4 clinical measures for assessing upper-extremity motor function in people with stroke: the upper-extremity subscale of the Fugl-Meyer Motor Test (UE-FM), the upper-extremity subscale of the Stroke Rehabilitation Assessment of Movement, the Action Research Arm Test (ARAT), and the Wolf Motor Function Test.Design: This was a prospective, longitudinal study.Methods: Fifty-three people with stroke were evaluated with the 4 measures at 4 time points (14, 30, 90, and 180 days after stroke). Thirty-five participants completed all of the assessments. The ceiling and floor effects, validity (concurrent validity and predictive validity), and responsiveness of each measure were examined. Interrater reliability and test-retest reliability also were examined.Results: All measures, except for the UE-FM, had significant floor effects or ceiling effects at one or more time points. The Spearman ρ correlation coefficient for each pair of the 4 measures was ≥.81, indicating high concurrent validity. The predictive validity of the 4 measures was satisfactory (Spearman ρ, ≥.51). The responsiveness of the 4 measures at 14 to 180 days after stroke was moderate (.52 ≤ effect size ≤ .79). The 4 measures had good interrater reliability (intraclass correlation coefficient [ICC], ≥.92) and test-retest reliability (ICC, ≥.97). Only the minimal detectable changes of the UE-FM (8% of the highest possible score) and the ARAT (6%) were satisfactory.Limitations: The sample size was too small to conduct data analysis according to type or severity of stroke. In addition, the timed component of the Wolf Motor Function Test was not used in this study.Conclusions: All 4 measures showed sufficient validity, responsiveness, and reliability in participants with stroke. The UE-FM for assessing impairment and the ARAT for assessing disability had satisfactory minimal detectable changes, supporting their utility in clinical settings.

Study Design: A prospective longitudinal study. Background: Diastasis recti abdominis (DRA) is defined as an increase in the inter-recti distance (IRD), or width of the linea alba. It is a common occurrence in women postpartum. Little information exists on the short- and long-term recovery of IRD and the relationship between changes in IRD and the functional performance of the abdominal muscles. Objectives: To investigate the natural recovery of IRD and abdominal muscle strength and endurance in women between 7 weeks and 6 months postpartum, and to examine the relationship between IRD and abdominal muscle function. Methods: Forty postpartum (25–37 years of age) and 20 age-matched, nulliparous females participated. IRD was measured at 4 locations (upper and lower margin of the umbilical ring, and 2.5 cm above and below the umbilical ring) with a 7.5-MHz linear ultrasound transducer. Trunk flexion and rotation strength and endurance were measured with manual muscle testing and curl-ups. Evaluation was conducted at 4 to 8 weeks and 6 to 8 months after childbirth in postpartum women, and only once for the nulliparous female controls. Results: During follow-up, the IRD at 2.5 cm above the umbilical ring and at the upper margin of the umbilical ring decreased (P = .013 and P = .002, respectively). The strength and static endurance of the abdominal muscles improved over time (P<.05). A negative correlation between IRD and abdominal muscle function at 7 weeks and 6 months postpartum was found (r = 0.34 to 0.51; P<.05, except for trunk flexion strength at 6 months postpartum [P = .064]). In addition, IRD changes between 7 weeks and 6 months postpartum were correlated with improvement in trunk flexion strength (Spearman rho = 0.38, P = .040). At 6 months after childbirth, postpartum women had greater mean ± SD IRDs at all 4 locations (from cranial to caudal: 1.80 ± 0.72, 2.13 ± 0.65, 1.81 ± 0.62, and 1.16 ± 0.58 cm) than those of nulliparous females (0.85 ± 0.26, 0.99 ± 0.31, 0.65 ± 0.23, and 0.43 ± 0.17 cm) (all P<.001). All abdominal strength and endurance measurements were less than those of nulliparous females (all P<.001). Conclusions: The IRD and abdominal muscle function of postpartum women improved but had not returned to normal values at 6 months after childbirth. Future research is essential to explore the need for intervention and, if needed, the effectiveness of specific intervention to reduce the size of IRD in postpartum women. J Orthop Sports Phys Ther 2011;41(6):435–443, Epub 2 February 2011. doi:10.2519/jospt.2011.3507

Background and Purpose— We compared the test–retest reliability, validity, and responsiveness of the Dynamic Gait Index, the 4-item Dynamic Gait Index, and the Functional Gait Assessment for assessment of walking in patients with stroke. Methods— Forty-five outpatients participating in the validity and responsiveness study were tested using the 3 walking measures as well as the 10-m walk test, Barthel Index, and Postural Assessment Scale for Stroke Patients. We tested them during the first week, then again after 2 months and 5 months of therapy. Another 48 chronic patients completed the 3 measures twice, 1 week apart, in the test–retest reliability study. Results— Thirty-five participants completed 3 time-point assessments. The Functional Gait Assessment showed the least floor and ceiling effects, indicating it has the best discriminative ability for patients with stroke with high walking function. We found the 3 measures were highly correlated with each other, indicating excellent concurrent validity, and all measures at the first week of therapy were moderately to highly correlated with the Barthel Index scores at 5 months, indicating good predictive validity. Responsiveness of the 3 measures was moderate during a 5-month period, and all showed good test–retest reliability. The minimal detectable changes between tests indicate acceptable random error. Conclusions— All 3 measures showed sufficient validity, responsiveness, and reliability for assessment of walking function in patients with stroke undergoing rehabilitation, but the Functional Gait Assessment is recommended for its psychometric properties.

Objective. To provide empirical justification for selecting motor scales for stroke patients, the authors compared the psychometric properties (validity, responsiveness, test-retest reliability, and smallest real difference [SRD]) of the Fugl-Meyer Motor Scale (FM), the simplified FM (S-FM), the Stroke Rehabilitation Assessment of Movement instrument (STREAM), and the simplified STREAM (S-STREAM). Methods. For the validity and responsiveness study, 50 inpatients were assessed with the FM and the STREAM at admission and discharge to a rehabilitation department. The scores of the S-FM and the S-STREAM were retrieved from their corresponding scales. For the test-retest reliability study, a therapist administered both scales on a different sample of 60 chronic patients on 2 occasions. Results. Only the S-STREAM had no notable floor or ceiling effects at admission and discharge. The 4 motor scales had good concurrent validity (rho ≥ .91) and satisfactory predictive validity (rho = .72-.77). The scales showed responsiveness (effect size d ≥ 0.34; standardized response mean ≥ 0.95; P < .0001), with the S-STREAM most responsive. The test-retest agreements of the scales were excellent (intraclass correlation coefficients ≥ .96). The SRD of the 4 scales was 10% of their corresponding highest score, indicating acceptable level of measurement error. The upper extremity and the lower extremity subscales of the 4 showed similar results. Conclusions. The 4 motor scales showed acceptable levels of reliability, validity, and responsiveness in stroke patients. The S-STREAM is recommended because it is short, responsive to change, and able to discriminate patients with severe or mild stroke.

Th wrists while walking or jogging on a treadmill at different speeds (54, 80, 107, and 134 m·min−1) and performing six different common daily activities for 5 min each. The monitors included the Fitbit Flex, the Garmin Vivofit, and the Jawbone UP. The common daily activity conditions included two sitting activities (playing a tablet computer game and folding laundry), two walking activities (pushing a stroller, carrying a bag), and two stair climbing activities (down and up). Absolute percentage error (APE) scores were computed to examine the accuracy between actual observed steps and monitor-detected steps. Results Under the treadmill condition, the APE ranged between 1.5% and 9.6%. Accuracy was improved at faster speeds (134 m·min−1) for all the monitors (APE < 2.5%). In the common daily activity conditions, substantial step counts were registered when folding laundry. All monitors significantly underestimated actual steps (all APE >33%) when pushing a stroller. Higher APE was observed when worn on the dominant wrist under the common daily activity conditions. Conclusions The wristband activity monitors examined were more accurate for measuring step counts between 80 and 134 m·min−1 as compared with a slower speed. Accuracy under each common daily activity condition ranged widely between monitors and activity, with less error when worn on the nondominant wrist. These results will help to inform researchers on the use and accuracy of wristband activity monitors for future studies....