UBIC, Departament de Fisioteràpia, Universitat de València, Valencia, Spain.
Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain.
J Neuroeng Rehabil. 2021 Apr 23;18(1):70. doi: 10.1186/s12984-021-00865-9.
The assessment of upper-limb motor impairments after stroke is usually performed using clinical scales and tests, which may lack accuracy and specificity and be biased. Although some instruments exist that are capable of evaluating hand functions and grasping during functional tasks, hand mobility and dexterity are generally either not specifically considered during clinical assessments or these examinations lack accuracy. This study aimed to determine the convergent validity, reliability, and sensitivity to impairment severity after a stroke of a dedicated, multi-touch app, named the Hand Assessment Test.
The hand mobility, coordination, and function of 88 individuals with stroke were assessed using the app, and their upper-limb functions were assessed using the Fugl-Meyer Assessment for Upper Extremity, the Jebsen-Taylor Hand Function Test, the Box and Block Test, and the Nine Hole Peg Test. Twenty-three participants were further considered to investigate inter- and intra-rater reliability, standard error of measurement, and the minimal detectable change threshold of the app. Finally, participants were categorized according to motor impairment severity and the sensitivity of the app relative to these classifications was investigated.
Significant correlations, of variable strengths, were found between the measurements performed by the app and the clinical scales and tests. Variable reliability, ranging from moderate to excellent, was found for all app measurements. Exercises that involved tapping and maximum finger-pincer grasp were sensitive to motor impairment severity.
The convergent validity, reliability, and sensitivity to motor impairment severity of the app, especially of those exercises that involved tapping and the maximum extension of the fingers, together with the widespread availability of the app, could support the use of this and similar apps to complement conventional clinical assessments of hand function after stroke.
脑卒中后上肢运动功能障碍的评估通常采用临床量表和测试，这些方法可能存在准确性和特异性不足以及存在偏倚的问题。虽然有一些仪器能够评估功能任务中的手功能和抓握能力，但在临床评估中通常没有专门考虑手部的活动性和灵巧性，或者这些检查缺乏准确性。本研究旨在确定一种专用的多点触控应用程序（称为 Hand Assessment Test）的相关性、可靠性和对脑卒中后损伤严重程度的敏感性。
使用该应用程序评估 88 名脑卒中患者的手部移动性、协调性和功能，并使用 Fugl-Meyer 上肢评估、Jebsen-Taylor 手功能测试、Box 和 Block 测试和 9 孔插板测试评估其上肢功能。进一步考虑了 23 名参与者，以研究该应用程序的组内和组间可靠性、测量标准误差和最小可检测变化阈值。最后，根据运动损伤严重程度对参与者进行分类，并研究该应用程序相对于这些分类的敏感性。
应用程序的测量值与临床量表和测试之间存在不同强度的显著相关性。所有应用程序测量值的可靠性均不同，从中等到优秀不等。涉及轻敲和最大手指抓握的练习对运动损伤严重程度敏感。
该应用程序的相关性、可靠性和对运动损伤严重程度的敏感性，特别是涉及轻敲和手指最大伸展的练习，以及该应用程序的广泛可用性，可能支持使用该应用程序和类似应用程序来补充脑卒中后手功能的常规临床评估。
