The responsiveness of the action research arm test and the Fugl-Meyer Assessment scale in chronic stroke patients

The responsiveness of the Action Research Arm (ARA) test and the upper extr emity motor section of the Fugl-Meyer Assessment (FMA) scale were compared in a cohort of 22 chronic stroke patients undergoing intensive forced use t reatment aimed at improvement of upper extremity function. The cohort consi sted of 13 men and 9 women, median age 58.5 years, median time since stroke 3.6 years. Responsiveness was defined as the sensitivity of an instrument to real change. Two baseline measurements were performed with a 2-week inte rval before the intervention, and a followup measurement after 2 weeks of i ntensive forced use treatment. The limits of agreement, according to the Bl and-Altman method, were computed as a measure of the test-retest reliabilit y. Two different measures of responsiveness were compared: (i) the number o f patients who improved more than the upper limit of agreement during the i ntervention; (ii) the responsiveness ratio. The limits of agreement, design ating the interval comprising 95% of the differences between two measuremen ts in a stable individual, were -5.7 to 6.2 and -5.0 to 6.6 for the ARA tes t and the FMA scale, respectively, The possible sum scores range from 0 to 57 (ARA) and from 0 to 66 (FMA). The number of patients who improved more t han the upper limit were 12 (54.5%) and 2 (9.1%); and the responsiveness ra tios were 2.03 and 0.41 for the ARA test and the FMA scale, respectively. T hese results strongly suggest that the ARA test is more responsive to impro vement in upper extremity function than the FMA scale in chronic stroke pat ients undergoing forced use treatment.