Assessment of the upper limb in acute stroke: The validity of hierarchal scoring for the Motor Assessment Scale

Abstract

Background/aim: Stroke is the greatest contributor to disability in Australian adults and much of this disability results from a stroke‐affected upper limb. This study aimed to determine the validity of hierarchal scoring for the upper limb subscale of the Motor Assessment Scale (UL‐MAS) in acute stroke using Rasch analysis. Method: This study applied Rasch analysis to 40 UL‐MAS assessment results across 25 subjects to determine the validity of the hierarchy of the three upper limb subsets: upper arm function (six), hand movements (seven) and advanced hand activities (eight). Rasch analysis examines the relationship between ‘item difficulty’ and ‘person ability’ and produces an output which represents the difficulty of each item in relation to each other. Results: As hypothesised, the hierarchy was upheld within subset 6. In subset 7, the hierarchy was not upheld. Results indicated that item 3 was the least difficult, followed by items 1, 4, 2, 5 and 6 in order of increasing difficulty. In subset 8 the hierarchy was not upheld. Results indicated that item 1 was the least difficult, followed by item 6, then 2 and 5 of equal value and then 3 and 4 of equal value. Conclusions: The hierarchal scoring is not supported for subsets 7 and 8 and future research is required to explore the validity of alternate scoring methods. At present, the authors recommend that the UL‐MAS should be scored non‐hierarchally, meaning that every item within the subsets should be scored regardless of its place within the hierarchy (UL‐MAS‐NH).

Older adults experience difficulty completing the lines and dots tasks of the Motor Assessment Scale

“…For younger and older stroke survivors, the lines and dots tasks are more difficult to complete than other UL-MAS advanced hand activities. [9,10] Our study is the first to investigate the performance of healthy adults on these tasks. The lines task in particular was too difficult for many individuals in our study.…”

“…[13,15] Subsequent Rasch analysis confirmed that for item eight, the motor behaviours are not ordered hierarchically. [9][10][11]16] Consistently, the two most difficult behaviours for stroke survivors to achieve on the advanced hand activities item are motor behaviours three and four. These two motor behaviours involve drawing 10 horizontal lines and making 10 dots in a set timeframe respectively and will hereafter be referred to as the 'lines task' and 'dots task'.…”

“…These three items, assessing 18 motor behaviours, are collectively known as the upper limb MAS (UL-MAS). [7][8][9][10] The UL-MAS is a uni-dimensional scale that measures a single construct, upper limb motor performance. [8,9,11,12] Each item is scored on a seven-point ordinal scale ranging from 0 (unable to perform any of the motor behaviours) to 6 (able to perform all six motor behaviours).…”

Methods of assessment of movement functions in the upper limb

“…Недостатком шкалы FMA-UE является эффект «пола и потолка» (относится к ситуации, когда у больного име-ется незначительная степень двигательного функциони-рования, которую не выявляет шкала, или, наоборот, он получает максимальную оценку, но все же испытывает некоторые трудности при выполнении комплексных дви-жений) [14,18]. Положительными моментами являются отсутствие необходимости специального обучения, доста-точные простота и мобильность, эталонность данного те-ста.…”

Rasch Analysis of a New Hierarchical Scoring System for Evaluating Hand Function on the Motor Assessment Scale for Stroke

“…Similarly, the hierarchical score for balanced sitting is based on graded increments of displacements of the person's center of mass. Since the hierarchical criteria for scoring the upper limb items are less obvious, several researchers have questioned [3, 5, 30–33] the behavioral hierarchies for items 6 (upper limb), 7 (hand movements), and 8 (advanced aand activities).…”