Original article
Measuring Upper Limb Capacity in Patients After Stroke: Reliability and Validity of the Stroke Upper Limb Capacity Scale

https://doi.org/10.1016/j.apmr.2011.03.028Get rights and content

Abstract

Houwink A, Roorda LD, Smits W, Molenaar IW, Geurts AC. Measuring upper limb capacity in patients after stroke: reliability and validity of the Stroke Upper Limb Capacity Scale.

Objective

To investigate the interrater reliability and construct validity of the Stroke Upper Limb Capacity Scale (SULCS).

Setting

Inpatient department of a rehabilitation center.

Participants

Patients after stroke (N=21; mean age ± SD, 61.7±7.9y; 57% men), undergoing inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

The SULCS was administered by occupational therapists (OTs) within 6 weeks after stroke (t1), 3 months after t1 by the same OT (t2), and within 1 week after t2 by another OT (t3). Interrater reliability, the repeatability between different raters, was assessed by calculating the intraclass correlation coefficient (ICC) based on the scores at t2 and t3. Construct validity, indicating agreement with hypotheses concerning the construct that is being measured, was assessed with Spearman rank correlation coefficient (ρ). The SULCS scores were cross-sectionally correlated with those of the Action Research Arm Test (ARAT) and the Rivermead Motor Assessment (RMA) at t1, and longitudinally with the respective change scores between t1 and t2.

Results

The SULCS (range, 0–10) had a high ICC (.94; 95% confidence interval, .86–.97) and strong cross-sectional correlation with both the ARAT and the RMA (ρ=.91 and ρ=.85, respectively), while the respective change scores showed a strong correlation with the ARAT (ρ=.71) and a moderate correlation with the RMA (ρ=.48).

Conclusions

The SULCS has good interrater reliability and construct validity.

Section snippets

Participants

Twenty-one patients after stroke who were admitted to a stroke ward of a regional rehabilitation center within a period of 10 months were included. At this ward, typically patients with a good potential to regain functional independence within 4 months after stroke were admitted. They were provided with, on average, five 30-minute sessions of individual physical therapy, three 30-minute sessions of individual occupational therapy, and five to eight 60-minute group sessions of physical or

Participants

The characteristics of the participants of this study and those of the reference cohort as described by Roorda et al12 are summarized in table 1. No significant differences were found in demographic or clinical characteristics or in the SULCS scores between these groups.

Reliability

The 2 measurements of the SULCS by the different raters (at t2 and t3) are presented in figure 1. Median SULCS scores at t2 and t3 were both 6.0 (interquartile range [IQR], 2.0–9.5 and 2.0–8.5, respectively). The interrater

Discussion

In this study, we investigated the reliability and validity of the SULCS, a new measure to assess upper limb capacity in patients after stroke. The results indicated that the SULCS had good interrater reliability (ICC=.94), which is comparable with the interrater reliability of the ARAT (ICC=.95; ICC=.98)14, 24 and the RMA (ICC=.88),8 as established in previous studies. The results of this study also demonstrated good construct validity of the SULCS based on high cross-sectional correlations

Conclusions

The SULCS is a new unidimensional and hierarchical measure of upper limb capacity in patients with arm-hand paresis due to stroke that has good interrater reliability and construct validity. Its short administration time and sensitivity in patients with no hand capacity seems to render the SULCS suitable for both scientific and clinical purposes.

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      Since the assessments were part of standard rehabilitative care, they were performed by approximately 15 occupational therapists over the 7-year inclusion period. The interrater reliability of the SULCS was excellent (intraclass correlation coefficient, .94).16 All occupational therapists received instructions and training on how to administer the SULCS, so that the test items were performed and scored uniformly.

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