Validity and reliability of the Adult Assisting Hand Assessment Stroke

Background: The Adult-Assisting Hand Assessment (Ad-AHA) Stroke is an observation-based instrument assessing the effectiveness of the spontaneous use of the affected hand when performing bimanual activities in adults after... [ view full abstract ]

Background:
The Adult-Assisting Hand Assessment (Ad-AHA) Stroke is an observation-based instrument assessing the effectiveness of the spontaneous use of the affected hand when performing bimanual activities in adults after stroke (Krumlinde-Sundholm,2013) This study investigates concurrent and discriminant validity and interrater and intrarater reliability of Ad-AHA Stroke.
Method:
Stroke survivors were recruited within the first six months post stroke. Concurrent validity was appraised by calculating correlations between Ad-AHA Stroke and ABILHAND Questionnaire, Action Arm Research Test (ARAT) and Upper Extremity Fugl-Meyer assessment (UE-FM). Differences in Ad-AHA Stroke scores for distinctive levels of motor impairment evaluated discriminant validity. Reliability was examined using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC).
Results:
Data of 118 stroke survivors was analyzed (mean age 66±12.3 years; mean time post stroke 92±52 days; mean UE-FM 35 points (±24 points). Correlations between Ad-AHA and clinical assessments was high (r=0.8–0.9), supporting concurrent validity. Significant differences in Ad-AHA scores were found for different levels of motor impairment, suggesting discriminant validity. ICC for interrater agreement was 0.99 (95% CI=0.99-0.99) and for intrarater 0.99 (95% CI=0.99-0.99). SEM was 1.64 and 2.15, and MDC was 5 and 6 for respectively interrater and intrarater reliability.
Conclusion:
Psychometric properties for the Ad-AHA Stroke are further underpinned by the results of this study.
Application to Practice:
The Ad-AHA Stroke is a novel test offering an innovative approach on upper limb assessment post stroke. Psychometric properties established in this study support the use in clinical practice and research.