Regional Rehabilitation Unit, Northwick Park Hospital, London, UK.
Disabil Rehabil. 2013 Aug;35(18):1513-8. doi: 10.3109/09638288.2012.743602. Epub 2013 Jan 7.
To develop a patient reported outcome measure of active and passive function in the hemiparetic upper limb.
Potential items for inclusion were identified through (a) systematic review and analysis of existing measures and (b) analysis of the primary goals for treatment in a spasticity service. Item reduction was achieved through consultation with a small, purposively selected multi-disciplinary group of experienced rehabilitation professionals (n = 10) in a three-round Delphi process. This was followed by a confirmatory survey with a larger group of clinicians (n = 36) and patients and carers (n = 13 pairs).
From an initial shortlist of 75 items, 23 items were initially identified for inclusion in the arm activity measure (ArmA), and subsequently refined to a 20-item instrument comprising 7 passive and 13 active function. In common with the six measures identified in the systematic review, a five-point ordinal scaling structure was chosen, with ratings based on activity over the preceding 7 days.
The ArmA is designed to measure passive and active function following focal interventions for the hemiparetic upper limb. Content and face validity have initially been addressed within the development process. The next phase of development has involved formal evaluation of psychometric properties.
In clinical practice or research, outcome measures in rehabilitation need to have face and content validity. Following stroke or brain injury, goals for rehabilitation of the hemiparetic upper limb may be: to restore active function, if there is return of motor control or to improve passive function making it easier to care for the limb (e.g. maintain hygiene) if no motor return is possible, measurement of both constructs should be considered. This study describes the systematic development of the ArmA, a measure of active and passive function in the hemiparetic upper limb.
开发一种用于测量偏瘫上肢主动和被动功能的患者报告结局测量工具。
通过（a）系统回顾和分析现有测量工具，以及（b）分析痉挛治疗服务中的主要治疗目标，确定潜在的纳入项目。通过在三轮 Delphi 过程中咨询一个由 10 名经验丰富的多学科康复专业人员组成的小而有针对性的多学科小组，实现了项目的精简。随后，对更大的临床医生群体（n=36）和患者及其照顾者（n=13 对）进行了验证性调查。
从最初的 75 项简短清单中，最初确定了 23 项纳入上肢活动测量工具（ArmA）的项目，随后将其精炼为包含 7 项被动功能和 13 项主动功能的 20 项工具。与系统评价中确定的六项测量工具一样，选择了五点等级量表结构，评分基于前 7 天的活动情况。
ArmA 旨在测量偏瘫上肢局灶性干预后的被动和主动功能。在开发过程中已经初步解决了内容和表面有效性问题。下一阶段的开发涉及对心理测量学特性的正式评估。
在临床实践或研究中，康复结局测量工具需要具有表面有效性和内容有效性。在中风或脑损伤后，偏瘫上肢康复的目标可能是：如果运动控制恢复，则恢复主动功能；或者如果没有运动恢复，则改善被动功能，使肢体更容易护理（例如保持卫生），应考虑测量这两种结构。本研究描述了 ArmA 的系统开发，这是一种测量偏瘫上肢主动和被动功能的工具。
