The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients - Rasch-based validation and relationship to upper limb impairment

Backgroun an Purpose - Chronic hemiparetic patients often retain the abilit y to manage activities requiring both hands, either through the use of the affected arm or compensation with the unaffected limb. A measure of this ov erall ability was developed by adapting and validating the ABILHAND questio nnaire through the Rasch measurement model. ABILHAND measures the patient's perceived difficulty in performing everyday manual activities. Methods - One hundred three chronic (>6 months) stroke outpatients (62% men ; mean age, 63 years) were assessed (74 in Belgium, 29 in Italy). They live d at home and walked independently and were screened for the absence of maj or cognitive deficits (dementia, aphasia, hemineglect). The patients were a dministered the ABILHAND questionnaire, the Brunnstrom upper limb motricity test, the box-and-block manual dexterity test, the Semmes-Weinstein tactil e sensation test, and the Geriatric Depression Scale. The brain lesion type and site were recorded. ABILHAND results were analyzed with the use of Win steps Rasch software. Results - The Rasch refinement of ABILHAND led to a change from the origina l unimanual and bimanual 56-item, 4-level scale to a bimanual 23-item, 3-le vel scale. The resulting ability scale had sufficient sensitivity to be cli nically useful. Rasch reliability was 0.90, and the item-difficulty hierarc hy was stable across demographic and clinical subgroups. Grip strength, mot ricity, dexterity, and depression were significantly correlated with the AB ILHAND measures. Conclusions - The ABILHAND questionnaire results in a valid person-centered measure of manual ability in everyday activities. The stability of the ite m-difficulty hierarchy across different patient classes further supports th e clinical application of the scale.