Stroke Arm Ladder

Overview


A literature search was conducted to identify all relevant publications on the psychometric properties of the Stroke Arm Ladder and revealed only the initial validation study. Results support preliminary validation of the psychometric properties, however further research is needed before the tool is ready for use clinically.

Floor/Ceiling Effects

Higgins, Finch, Kopec and Mayo (2011) examined the ceiling effects of the Stroke Arm Ladder in patients with stroke and found no floor or ceiling effects, as no patients scored below or above the easiest and hardest items (respectively). It should be noted that this sample only included patients up to 7 months post-stroke and thus, the Stroke Arm Ladder should not be used for patients past 7 months post-stroke until further validation testing is completed.

Reliability

Internal consistency
Higgins, Finch, Kopec and Mayo (2011) investigated the internal consistency (Cronbach’s alpha = 0.97).

Intra-rater
Intra-rater reliability has not been examined.

Inter-rater
Inter-rater reliability has not been examined.

Test-retest
Test-retest reliability has not been examined.

Validity

Content

Higgins, Finch, Kopec and Mayo (2011) investigated the content validity of the Stroke Arm Ladder in clients with stroke. In the development of the Stroke Arm Ladder, 49 items from validated tests and indices used to assess upper extremity function and movement, such as the Box and Block Tests, were selected. 15 items were deleted for reasons such as redundancy and lack of fit to the model. When validating the 34 items selected for the final version of the measure, all patients with stroke had fit residuals between -2.0 and +2.0. The hierarchical sequencing of the items was confirmed using Rasch analysis. The results from this study suggest that all 34 items in the Stroke and Arm Ladder reflect the same construct.

Criterion

Concurrent

Concurrent validity has not been examined.

Predictive

Predictive validity has not been examined.

Sensitivity/ Specificity

Sensititive/specificity has not been examined.

Construct

Convergent/Discriminant
Higgins, Finch, Kopec and Mayo (2011) investigated the convergent/ of the Stroke Arm Ladder by comparing it to the index of global functional recovery (total score on the Stroke Rehabilitation Assessment of Movement). Excellent correlation was found between the two measures (r=0.6, P<0.0001). The authors also reviewed the correlation between the Stroke Arm Ladder and the mental and emotional subsets of the Medical Outcomes Study Short Form 36 (SF-36), and found poor correlation (r=0.2, P<0.0001). Results from this study indicate that the Stroke Arm Ladder adequately measures the construct of upper extremity function, with limited ability to assess mental and emotional status following stroke, as intended by the developers.

Known Groups
Higgins, Finch, Koppec and Mayo (2011) examined known groups validity of the Stroke Arm Ladder in patients with stroke. Patients with stroke were classified as having mild, mild-moderate, moderate or severe stroke using the Canadian Neurological Scale (CNS). Results revealed that the Stroke Arm Ladder was able to differentiate two out of four different levels of stroke severity: mild and severe Patients classified as having either moderate or severe stroke scored similarly on the measure, as did patients classified as having mild and mild-moderate stroke. Patients classified as having moderate or severe stroke differed significantly from those classified as having mild or mild-moderate stroke, indicating the ability of the Stroke Arm Ladder to differentiate between the two extremes (mild versus severe).

Responsiveness

Responsiveness has not been examined.

References
  • Higgins, J., Finch, L.E., Kopec, J. & Mayo, N.E. (2011). Development and initial psychometric evaluation of the Stroke Arm Ladder: A measure of upper extremity function post stroke. Clinical Rehabilitation, 25(8), 740-759.