Chedoke Arm and Hand Activity Inventory (CAHAI)

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Chedoke Arm and Hand Activity Inventory (CAHAI) in individuals with stroke. We identified four studies. The CAHAI appears to be responsive in clients with stroke.

Floor/Ceiling Effects

No studies have examined floor/ceiling effects of the CAHAI.

Reliability

Internal Consistency:
Barreca, Gowland, Stratford, Huijbregts, Griffiths, Torresin, Dunkley, Miller, and Masters (2004) assessed the internal consistency of the CAHAI in 100 clients with stroke. Internal consistency of the CAHAI, as calculated using Cronbach’s Coefficient Alpha was excellent (α = 0.98).

Barreca, Stratford, Masters, Lambert, Griffiths, and McBay (2006) examined the internal consistency of the CAHAI-7, CAHAI-8, and CAHAI-9 in 39 clients with stroke. Internal consistency of all shortened versions of the CAHAI, as calculated using Cronbach’s Coefficient Alpha, was excellent (α = 0.97; α = 0.98; α = 0.98, respectively).

Test-retest:
Barreca et al. (2006) examined the test-retest reliability of the shortened version of the CAHAI in 39 clients with stroke. Participants were stratified into two different groups based on the amount of expected improvement. Participants were re-assessed following a 36 hour interval. The test-retest reliability as calculated using Intraclass Correlation Coefficient (ICC) was excellent for all shortened versions: CAHAI-7 (ICC = 0.96), CAHAI-8 (ICC = 0.97), and CAHAI 9 (ICC = 0.97).

Intra-rater:
No studies have examined the intra-rater reliability of the CAHAI.

Inter-rater:
Barreca, Stratford, Lambert, Masters, and Streiner (2005) assessed the inter-rater reliability of the CAHAI in 39 clients with stroke. Participants were stratified into two different groups based on the amount of expected improvement. Participants were re-assessed following a 36 hours interval. The inter-rater reliability as calculated using Intraclass Correlation Coefficient (ICC), was excellent (ICC = 0.98).

Validity

Content:
Barreca et al. (2004) performed a literature review to generate items for the CAHAI. From this review, 177 items were selected. Eighty-one clients with stroke, their families and caregivers were surveyed about important and relevant items regarding stroke recovery, which generated an additional 574 items. To reduce the 725 generated items to 26 items, only bilateral, gender-neutral items, that fell into the domains identified by the clients as important that were easy to obtain were kept. This version, with 26 items, was then tested in 20 participants with stroke. Items that were difficult to standardize or those with the potential for safety concerns were eliminated. Items with a high degree of difficulty were added in order to minimize possible ceiling effects. Inter-item correlation analyses of this new version (which contained 25 items), identified some redundant items (r > 0.90). Items with poor frequency endorsement, difficulty to standardize and high inter-item correlation were eliminated, resulting in the 13 finalized items.

Criterion:
Concurrent:
Barreca, Stratford, Masters, Lambert, & Griffiths (2006b) examined the ability of the CAHAI-9 to predict the scores and change scores of the original CAHAI in 105 clients with stroke. Mean scores and mean change scores of the CAHAI-9 accurately predicted means scores and mean change scores of the CAHAI. However, individual scores and individual change scores of the CAHAI-9 displayed moderate variability in predicting individual scores and change scores of CAHAI. The findings indicate that the CAHAI-9 should not be administered with the intent to predict the CAHAI.

Predictive:
No studies have examined the predictive validity of the CAHAI.

Construct:
Convergent/Discriminant:
Barreca et al. (2005) estimated convergent validity of the CAHAI by comparing it to Chedoke-McMaster Stroke Assessment (CMSA – Gowland, Stratford, Ward, Moreland Torresin, VanHullenaar et al., 1993; Gowland, VanHullenaar, Torresin, et al., 1995) arm-hand sum score, and with the Action Research Arm Test (ARAT – Lyle, 1981) in 39 participants with stroke. Assessments were performed at baseline and 2 to 6 weeks later. Correlations, as calculated using Pearson Correlation Coefficient were excellent between the CAHAI and the ARAT (r = 0.93) and between the CAHAI and the CMSA arm-hand at baseline (r = 0.81) and at follow up (r = 0.89). In the same study, the authors analyzed discriminant validity of the CAHAI by comparing it to the CMSA shoulder pain score in the same 39 participants with stroke. The correlation between the CAHAI and CMSA shoulder pain score as calculated using Pearson Correlation, was adequate at baseline (r = 0.47) and at follow-up (r = 0.39).

Barreca et al. (2006) assessed the convergent validity of the CAHAI-7, CAHAI-8 and CAHAI-9 by comparing them to the Action Research Arm Test (ARAT), CAHAI and CMSA in 39 individuals with stroke. Pearson Correlations were used. Correlations between the ARAT and CAHAI-7 (r = 0.95), CAHAI-8 (r = 0.95) and CAHAI-9 (r = 0.94) were all excellent , as well as between the CAHAI and all the shortened versions (r = 0.99), and between the CMSA and CAHAI-7 (r = 0.85), CAHAI-8 (r = 0.84), and CAHAI-9 (r = 0.84).

Barreca et al., (2006b) determined the convergent validity of the CAHAI-9 and CAHAI by comparing them to the ARAT (Lyle, 1981) in 105 individuals with stroke. Re-assessments were performed with a 36 hours interval. Pearson Correlation Coefficients were excellent between the CAHAI-9 and ARAT at baseline (r = 0.93), and at follow-up (r = 0.95), as well as between the CAHAI at baseline (r = 0.93), and at follow-up (r = 0.95).

Known groups:
Barreca et al. (2005) analyzed the longitudinal validity of the CAHAI in 39 clients with stroke by comparing change scores on the CAHAI with change scores on the arm-hand sum and on the shoulder pain dimensions of the Chedoke-McMaster Stroke Assessment (CMSA – Gowland et al., 1995) and on the Action Research Arm Test (ARAT – Lyle, 1981). Change scores correlations, as calculated using Pearson Correlation Coefficient, was excellent between the CAHAI and the ARAT (r = 0.86), adequate between the CAHAI and the CMSA arm-hand sum (r = 0.52) and poor between the CAHAI and the CMSA shoulder pain (r = -0.24). In a second analysis, Barreca et al. (2005) analyzed whether the CAHAI was more adept then the CMSA  and the ARAT at distinguishing change in patients with mild/moderate impairments from patients with severe impairments in 39 clients with stroke. Longitudinal/known groups validity, as calculated using Receiver Operating Characteristic (ROC) demonstrated an excellent area under the curve for the CAHAI (ROC = 0.95). The ARAT and CMSA presented an adequate area under the curve (ROC = 0.88; ROC = 0.76), respectively.
Note: ROC curve analysis quantifies a measure’s ability to distinguish between groups as an area under the ROC curve. Greater areas indicate the measure is better at discriminating between individuals in the two groups.

Barreca et al. (2006) assessed the longitudinal validity of the CAHAI and its three shortened versions in 39 participants with stroke. Participants were divided according to stroke’s severity into acute and chronic groups. The CAHAI, CAHAI-7, CAHAI-8, and CAHAI-9 were administered at admission and discharge (2 to 6 weeks after admission) to verify which version was more adept to detecting changes in patients with acute stroke from patients with chronic stroke. Longitudinal/known groups validity, as calculated using Receiver Operating Characteristic (ROC) demonstrated an excellent area under the curve for all versions of the CAHAI as follows: CAHAI (ROC = 0.95); CAHAI -7 (ROC = 0.97); CAHAI-8 (ROC = 0.93), and CAHAI-9 (ROC = 0.94), meaning all versions of CAHAI are equally able to distinguish changes between different groups in stroke.

Barreca et al. (2006b) examined the longitudinal validity of the CAHAI, CAHAI-9 and the ARAT in 105 individuals with stroke. Participants were stratified between mild/moderate impairments and severe impairments, and those with mild/moderate impairments were expected to show greater changes across two repeated measures. The three outcome measures were administered at two points in time to verify which of them were more adept to detecting changes in clients with mild/moderate impairment from clients with severe impairment. Longitudinal/known groups validity, as calculated using Receiver Operating Characteristics, were adequate for the ARAT (ROC = 0.72), the CAHAI -9 (ROC = 0.82), and the CAHAI (ROC = 0.86). This ROC analysis indicated that the CAHAI was the best measure to detect change among patients with mild/moderate impairment from patients with severe impairment.

Responsiveness

Barreca et al. (2005) assessed the minimal detectable change of the CAHAI in 39 clients with stroke. Participants were assessed at two points in time: at admission, and after 2 to 6 weeks. For the CAHAI, the minimal detectable change was 6.3 points, meaning that stable patients displayed random fluctuations of 6.3 CAHAI points or less when assessed on two different occasions.

References
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  • Barreca, S.R., Stratford, P.W., Lambert, C.L., Masters, L.M., & Streiner, D.L. (2005). Test-retest reliability, validity, and sensitivity of the Chedoke Arm and Hand Activity Inventory: a new measure of upper-limb function for survivors of stroke. Archives of Physical Medicine and Rehabilitation, 86, 1616-1622.
  • Barreca, S.R., Stratford, P.W., Masters, L.M., Lambert, C.L., Griffiths, J., McBay, C. (2006). Validation of three shortened versions of the Chedoke Arm and Hand Activity Inventory. Physiotherapy Canada, 58, 148-156.
  • Barreca, S.R., Stratford, P.W., Masters, L.M., Lambert, C.L., Griffiths, J. (2006b). Comparing two versions of the Chedoke Arm and Hand Activity Inventory with the Action Research Arm Test. Physical Therapy, 86(2), 245-253.
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