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Rasch Analysis of a New Hierarchical Scoring System for Evaluating Hand Function on the Motor Assessment Scale for Stroke

DOI: 10.1155/2014/730298

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Objectives. (1) To develop two independent measurement scales for use as items assessing hand movements and hand activities within the Motor Assessment Scale (MAS), an existing instrument used for clinical assessment of motor performance in stroke survivors; (2) To examine the psychometric properties of these new measurement scales. Design. Scale development, followed by a multicenter observational study. Setting. Inpatient and outpatient occupational therapy programs in eight hospital and rehabilitation facilities in the United States and Canada. Participants. Patients receiving stroke rehabilitation following left (52%) or right (48%) cerebrovascular accident; mean age 64.2 years (sd 15); median 1 month since stroke onset. Intervention. Not applicable. Main Outcome Measures. Data were tested for unidimensionality and reliability, and behavioral criteria were ordered according to difficulty level with Rasch analysis. Results. The new scales assessing hand movements and hand activities met Rasch expectations of unidimensionality and reliability. Conclusion. Following a multistep process of test development, analysis, and refinement, we have redesigned the two scales that comprise the hand function items on the MAS. The hand movement scale contains an empirically validated 10-behavior hierarchy and the hand activities item contains an empirically validated 8-behavior hierarchy. 1. Introduction To maximize functional outcomes, occupational therapists and physical therapists assess and provide interventions related to gross mobility, sitting and standing balance, ambulation, and motor performance of the arm and hand. Rehabilitation clinicians use standardized assessment tools on a daily basis to determine patients’ baseline performance, guide treatment planning, monitor ongoing progress, establish recommendations for follow-up care after discharge, and evaluate the effectiveness of interventions. The Motor Assessment Scale (MAS) [1] provides rehabilitation clinicians and researchers with a single, quickly administered assessment of eight categories of poststroke motor function: supine-to-sidelying; supine-to-sitting; balanced sitting; sitting-to-standing; walking; upper arm function; hand movements; and advanced hand activities. Each category is scored on a 7-point scale (0–6), based on a person’s ability to perform specific tasks. The tasks in each category are intended to be hierarchical; that is, the ability to accomplish task 6 implies the ability to accomplish tasks 1 through 5. This arrangement reduces administration time and increases its appeal to


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