Evaluates the functional ability of paretic arm and hand to perform tasks. The Chedoke Arm and Hand Activity Inventory (CAHAI) is used to assess functional ability of the paretic arm and hand.[1]. Top Stroke Rehabil. Jul-Aug;18(4) doi: /tsr Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9): perceived clinical utility.

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The Chedoke Arm and Hand Activity Inventory CAHAI is a new, validated upper-limb measure that uses a 7-point quantitative scale in order to assess functional recovery of the arm and hand after a stroke.

The purposes of this study were: One hundred five people with upper-limb dysfunction following invenntory stroke were stratified into 2 impairment groups mild to moderate and severewhich were expected to change by different amounts. Receiver operating characteristic curves, Pearson product moment adtivity of correlation, and regression analyses were used.

Compromised upper-limb functional status plays a prominent role in the degree of disability experienced by people who have had a stroke. Over the years, there has been dissatisfaction with the ability to assess recovery in the paretic upper limb of people who have had a stroke.

This dissatisfaction has led to the development and application chsdoke numerous outcome measures. Existing measures have been criticized for focusing on impairments or consisting of contrived tasks that do not reflect real-life activities. Comprehensive descriptions of the conceptual framework, development, and psychometric properties of the CAHAI are detailed elsewhere.

Content validity and sound psychometric properties played prominent roles in determining the final CAHAI item composition.

Preference was given to items that reflected real-life bilateral functional activities and maximized the range of normative upper-limb movements and grasps. The final measure consists of 13 items—hereafter referred to as the CAHAI—and takes approximately 25 minutes to administer and score.

Each item is scored on a 7-point scale similar to that of the Functional Independence Measure.

Chedoke Arm and Hand Activity Inventory

Previous investigations 78 have supported the psychometric properties of the CAHAI, and the following measurement properties have been reported: A curve area of 0.

With so many upper-limb measures available, it is natural to question the development of another measure. A noted barrier to the successful implementation of standardized outcome measures is the time it takes to administer and score the measures. With the thought of increased efficiency in mind, a previous study 8 investigated the feasibility of reducing the number aand CAHAI items and ultimately its administration time.

There were 2 objectives to this study: This study was conducted at 4 facilities in the vicinity of Hamilton, Ontario, Canada, that provided either inpatient or outpatient rehabilitation services. One hundred five participants who experienced their first stroke fulfilled the eligibility criteria: Participants who had the following inventroy were excluded: Written informed consent was obtained from each participant or his or her substitute decision maker.

The CAHAI was administered to the participants by their treating therapist at their initial visit and following completion of their rehabilitation program. A total of 11 treating occupational therapists and physical therapists, with an average of 8. Random assignment determined whether the treating therapist or the research therapist would complete the assessment first and which measure, the CAHAI or the ARAT, was administered first by the research therapist.

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Prior to the study, written guidelines for the ARAT were developed from the literature. In addition, the CMSA was administered at the initial invenyory, and the information was used to categorize participants for the longitudinal validity component of this investigation. The longitudinal validity component applied a strong group construct validation design that made use of the clinical history of the condition being studied. International Classification of Diseases, Clinical Modification.

Practice Management Information Corp; The cross-sectional validity comparison of the 2 CAHAI versions applied a convergent construct validation design. Comparisons were performed for data gathered at the initial and follow-up assessments. Total scores are obtained by summing the item scores. Accordingly, total scores can range from 13 to 91, with higher scores reflecting greater ability.

Spearman rank-order correlation coefficient and intraclass correlation coefficient have been used to demonstrate high levels of interrater reliability. Receiver operating characteristic 19 curve analysis was applied to determine whether the known group longitudinal validity coefficients—expressed as the area under the ROC curve—of the 2 CAHAI versions exceeded that of the ARAT. The convergent acrivity construct validity analysis applied a Pearson product moment coefficient of correlation r.

It uses the Fisher z transformation, which converts the Pearson r to a normal distribution and, in this way, allows a comparison of 2 or more measures with a dependent variable eg, gains in upper-limb function. In a previously reported pilot hajd of 39 patients, we found the ROC curve areas to be 0.

Applying these assumptions, a sample size of 50 people with stroke per group, or in total, were required. The longitudinal validity analysis produced the following ROC curve areas: The difference in point estimates of the 2 CAHAI versions was less than the declared a priori clinical difference of 0. Table 3 contains the convergent cross-sectional construct validity correlation coefficients with the ARAT. The correlation between the scores of the 2 versions of the CAHAI at both the initial and follow-up visits was.

The predictive equations for data unventory at the 2 assessment points were almost identical:.

Chedoke Arm and Hand Activity Inventory (CAHAI)

The relationship for the follow-up scores not shown was virtually identical to that shown in Figure 1. During the past 3 decades, there has been a substantial increase in the number of outcome measures for people with stroke.

Presumably, as better measures are developed, inferior measures will be discarded. The current investigation focused on the first 2 criteria. Given that the ARAT is an established measure, simply showing equivalence between the measures with no additional benefit of the CAHAI would add to the plethora of measures with no added value to clinicians or researchers. For this reason, we framed our first research question to ask whether the longitudinal validity of scores on the CAHAI versions was superior to that of scores on the ARAT.

We recognized that the increased efficiency associated with the shorter measure would come at a cost to its validity, and we examined whether the cost in terms of validity would be too great and render the proposed shorter measure ineffective.

From its conception, the CAHAI was designed specifically to assess upper-limb function in people with stroke, whereas the ARAT was derived from a measure, designed into assess upper-limb dysfunction in the general neurological population.

Careful consideration of the theoretical constructs underpinning the CAHAI has resulted in a tool that is consistent with the current frameworks of motor learning and performance.

The principal goal is to assess upper-limb functional recovery, and a secondary goal may be to predict CAHAI scores. If the intended application of the CAHAI-9 is to predict CAHAI scores and change scores for a patient, our findings suggest that there is too much error to accomplish this with a high level of precision. If the purpose is to assess upper-limb recovery, there is strong evidence that the CAHAI is superior to the CAHAI-9; however, based on the difference in ROC curve areas, it is less clear whether the superiority is clinically important.


Within the context of our article, the greater the area under an ROC curve, the higher the probability that the measure would correctly identify true change in upper-limb function. For example, in a pair of patients who have both truly changed by different amounts, using a measure that has a curve area of 0. We acknowledge that our choice of 0. Accordingly, we split the difference.

If one accepts a difference in curve areas of 0.

This uncertainty is a consequence of our underestimating the actjvity sample size. Specifically, our pilot study data 8 overestimated the absolute curve areas and the correlation between curve areas and underestimated the true difference in curve areas.

Applying the results from our current study ie, ROC curve areas of 0. However, ascertaining the validity of data for a measure and the relative validity of data for competing measures is an ongoing process. Confidence in our findings will be dependent on the extent to which similar results are obtained in subsequent investigations conducted by other investigators applying different validation constructs.

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View large Download slide. This study was approved by the research ethics boards of the participating hospitals.

Administration and Scoring Manual

Ms Lambert and Mr Griffiths provided subjects and data collection. Mr Stratford provided data analysis.

Ms Masters provided project management, data collection, and clerical support. Recovery of upper extremity function in stroke patients: Heart and Stroke Foundation of Ontario. Management of the Post Stroke Arm and Hand: Treatment Recommendations of the Consensus Panel.

Accessed April 20, A performance test for assessment of upper limb function in physical rehabilitation and research. The post-stroke hemiplegic patient, 1: Functional evaluation of upper extremity use following stroke: International Classification of Functioning, Disability and Health. Uniform Data System for Medical Rehabilitation.

The intra- and interrater reliability of the Action Research Arm test: A method of comparing the areas under receiving operating characteristic curves derived from the same cases.

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