Rivermead Motor Assessment (RMA)

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Rivermead Motor Assessment (RMA).

Floor/Ceiling Effects

Williams, Robertson, Greenwood, Goldie, and Morris (2006) examined the concurrent validity of a new measure, the High-Level Mobility Assessment Tool (HiMAT) and the Gross Function subscale of the RMA in 103 patients following traumatic brain injury. The Gross Function subscale of the RMA was found to have a poor ceiling effect, with 51.5% of patients achieving the maximum score.

Reliability

Internal consistency:
Kurtais et al. (2009) investigated the internal consistency of the RMA in 107 patients with stroke. Internal consistency of the RMA, as calculated using Cronbach’s alpha was excellent for all RMA subscales (Gross Function α = 0.93; Leg and Trunk α = 0.88; and Arm α = 0.95).

Test-retest:
Lincoln and Leadbitter (1979) had 7 raters examine 10 patients with acute stroke (4-week interval) and reported adequate test-retest reliability of the Gross Function subscale (r = 0.66), and excellent correlations for the Leg and Trunk, and Arm subscales (r = 0.93, and r = 0.88, respectively) of the RMA.

Inter-rater:
Lincoln and Leadbitter (1979) examined the inter-rater reliability of the RMA by having 7 raters evaluate 7 patients who were administered the RMA by videotape. Analysis of variance (ANOVA) of the scores obtained indicated that for all three subscales, variability between patients was higher than the variability between raters (F tests from ANOVA are reported but no ICCs). On the Gross Function and Leg and Trunk subscales, there were no significant differences on average scores for all patients across all raters. For the Arm subscale, there was significant difference across raters, attributed to only one of the seven raters. Revised scoring instructions were therefore produced for the Arm subscale, but further testing is required.

Validity

Content:
Content validity with Guttman scaling is evaluated on the extent to which total scores predict the number of consecutive items passed. In a study of 51 patients with stroke, critical values for two indices, coefficient of reproducibility and coefficient of scalability, were all exceeded. The results of this study confirm the existence of a valid, cumulative, and unidimentional Guttman scale (Lincoln & Leadbitter, 1979).

Criterion:
Concurrent:
Endres, Nyary, Banhidi, and Deak (1990) administered the RMA and the Barthel Index to 53 patients who presented with a stroke and who took part in a rehabilitation program. Scores on the RMA correlated excellently with scores on the Barthel Index at initial (r = 0.84), 1 month (r = 0.78), and 1 year (r = 0.63) follow-up.

Predictive.

Collin and Wade (1990) reported that a low RMA Gross Motor score at 6 weeks post-stroke was found to be predictive of failure to walk at 18 months post-stroke.

Construct:
Convergent/Discriminant:
Collin and Wade (1990) examined the convergent validity of the RMA with two different tests: the Motricity Index (Collin & Wade, 1990), the Trunk Control Test (Collin & Wade, 1990). They believed the Motricity Index and the Trunk Control Test were the tests requiring comparison, and the RMA was used as the “established” measure. The correlations between the Motricity Index Upper Extremity subscale scores and the RMA Upper Extremity subscale scores across 3 time periods (6, 12, and 18 weeks after stroke) were excellent (r = 0.76, 0.73, and 0.74, respectively).

Soyuer and Soyuer (2005) examined the convergent validity of the RMA with the Functional Independence Measure (FIM – Keith, Granger, Hamilton, & Sherwin, 1987) in 100 patients with ischemic stroke. The assessments were conducted 7-10 days and 3 months post-stroke. At 7-10 days post-stroke, the total score for the RMA had an excellent correlation with the total score on the FIM (r = 0.87) and with the FIM Motor subscale (r = 0.90). The total score of the RMA had an adequate correlation with the FIM Cognitive subscale (r = 0.46). At 3 months post-stroke the total RMA had an excellent correlation with the total score on the FIM (r = 0.88) and with the Motor subscale of the FIM (r = 0.89). The RMA had an adequate correlation with the Cognitive subscale of the FIM (r = 0.52).

Sackley and Lincoln (1990) examined the convergent validity of a verbal method of completing the Gross Function subscale of the RMA with the typical performance method of completion in 49 patients with chronic stroke. An excellent correlation was found between these two methods of administration (r = 0.98).

Kurtais et al. (2009) examined the convergent validity of the RMA with the Functional Independence Measure (FIM) in 107 patients with stroke (mean 5.6 months post-stroke). Assessments were performed at admission and discharge from a rehabilitation unit. The Gross Function and Leg and Trunk subscales of the RMA had excellent correlation with all three sections of the FIM (Motor; Self-Care; and Mobility) on admission and discharge (ranging from 0.702 to 0.865); however, the Arm subscale of the RMA was found to only have adequate correlation with all three sections of the FIM at both admission and discharge from the rehabilitation unit (0.386-0.483).

Known groups :
Endres et al. (1990) administered the RMA to 53 patients with stroke participating in a rehabilitation program. Patients were grouped according to RMA motor deficit scores at entry (RMA score 0-9; 10-15; and >15). Adequate correlations were found between RMA score and infact size at initial (r = -0.52), 1 month (r = -0.47), and 1 year (r = -0.53) follow-up sessions.

Responsiveness

Collen, Wade, and Batshaw (1990) reported that a total score difference of ±3 points in the RMA is likely to represent a clinically relevant change in functional level.

Kurtais et al. (2009) examined the responsiveness of the RMA (adapted for use in a Turkish population) in 107 patients with stroke (mean 5.6 months post-stroke). Assessments were performed at admission and discharge from a rehabilitation unit. The effect size and standard response mean (SRM) were calculated for all three subscales of the RMA (Gross Function; Leg and Trunk; and Arm). Moderate effect size was found for the Gross Function subscale (0.51) and small effect sizes for the Leg and Trunk and Arm subscales (0.45 and 0.38 respectively). The Gross Function, Leg and Trunk and Arm subscales had SRMs of 0.83, 0.86 and 0.60 respectively.

References
  • Adams, S. A., Ashburn, A., Pickering, R. M., Taylor, D. (1997). The scalability of the Rivermead Motor Assessment in acute stroke patients. Clin Rehabil, 11, 42-51.
  • Adams, S. A., Pickering, R. M., Ashburn, A., Lincoln, N. B. (1997). The scalability of the Rivermead Motor Assessment in nonacute stroke patients. Clin Rehabil, 52-59.
  • Barer, D., Nouri, F. (1989). Measurement of activities of daily living. Clin Rehabil, 3, 179-187.
  • Collin, C., Wade, D. (1990). Assessing motor impairment after stroke: A pilot reliability study. Journal of Neurology, Neurosurgery, and Psychiatry, 53, 576-579.
  • Collen, F. M., Wade, D. T., Bradshaw, C. A. (1990). Mobility after stroke: Reliability of measures of impairment and disability. Int Disabil Stud, 12, 6-9.
  • Collen, F. M., Wade, D. T., Robb, G. F., Bradshaw, C. M. (1991). The Rivermead Mobility Index: A further development of the Rivermead motor assessment. Int Disabil Stud, 13, 50-54.
  • Collin, C., Wade, D. (1990). Assessing motor impairment after stroke: a pilot reliability study. J Neurol Neurosurg Psychiatry, 53(7), 576-579.
  • Endres, M., Nyary, I., Banhidi, M., Deak, G. (1990). Stroke rehabilitation: A method and evaluation. International Journal of Rehabilitation Research, 13, 225-236.
  • Hsieh, C-L., Hsueh, I-P., Mao, H-F. (2000). Validity and responsiveness of the Rivermead Mobility Index in stroke patients. Journal of Rehabilitation Medicine, 32(3), 140-142.
  • Keith, R. A., Granger, C. V., Hamilton, B. B., Sherwin, F. S. (1987). The functional independence measure: A new tool for rehabilitation. Adv Clin Rehabil, 1, 6-18.
  • Kurtais, Y., Kucukdeveci, A., Elhan, A., Yilmaz, A., Kalli, T., Sonel Tur, B. et al. (2009). Psychometric properties of the Rivermead Motor Assessment: Its utility in stroke. Journal of Rehabilitation Medicine, 41, 1055-1061.
  • Lincoln, N. B., Leadbitter, D. Assessment of motor function in stroke patients. Physiotherapy, 65, 48-51.
  • Sackley, C., Lincoln, N. (1990). The verbal administration of the gross function section of the Rivermead Motor Assessment. Clin Rehabil, 4, 301-303.
  • Soyuer, F., Soyuer, A. (2005). Ischemic stroke: Motor impairment and disability with relation to age and lesion location (Turkish). Journal of Neurological Sciences, 22(1), 43-49.
  • Streiner, D. L., Norman, G. R. (1989). Health measurement scales: A practical guide to their development and use. Oxford: Oxford University Press.
  • Tyson, S., DeSouza, L. (2002). A systematic review of methods to measure balance and walking post-stroke. Part 1: Ordinal scales. Physical Therapy Reviews, 7, 173-186.
  • Williams, G., Robertson, V., Greenwood, K., Goldie, P., Morris, M. E. (2006). The concurrent validity and responsiveness of the high-level mobility assessment tool for measuring the mobility limitations of people with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 87(3), 437-442.