The intra- and interrater reliability of the action research arm test: A practical test of upper extremity function in patients with stroke

Objectives: To determine the intra- and interrater reliability of the Action Research Arm (ARA) test, to assess its ability to detect a minimal clinically important difference (MCID) of 5.7 points, and to identify less reliable test items. Design: Intrarater reliability of the sum scores and of individual items was assessed by comparing (1) the ratings of the laboratory measurements of 20 patients with the ratings of the same measurements recorded on videotape by the original rater, and (2) the repeated ratings of videotaped measurements by the same rater. Interrater reliability was assessed by comparing the ratings of the videotaped measurements of 2 raters. The resulting limits of agreement were compared with the MCID. Patients: Stratified sample, based on the intake ARA score, of 20 chronic stroke patients (median age, 62yr; median time since stroke onset, 3.6yr; mean intake ARA score, 29.2). Main Outcome Measures: Spearman's rank-order correlation coefficient (Spearman's rho); intraclass correlation coefficient (ICC); mean difference and limits of agreement, based on ARA sum scores; and weighted kappa, based on individual items. Results: All intra- and interrater Spearman's rho and ICC values were higher than .98. The mean difference between ratings was highest for the interrater pair (.75; 95% confidence interval, .02-1.48), suggesting a small systematic difference between raters. Intrarater limits of agreement were -1.66 to 2.26; interrater limits of agreement were -2.35 to 3.85. Median weighted kappas exceeded .92. Conclusion: The high intra- and interrater reliability of the ARA test was confirmed, as was its ability to detect a clinically relevant difference of 5.7 points

Systematics of heavy-ion fusion hindrance at extreme sub-barrier energies

The recent discovery of hindrance in heavy-ion induced fusion reactions at extreme sub-barrier energies represents a challenge for theoretical models. Previously, it has been shown that in medium-heavy systems, the onset of fusion hindrance depends strongly on the "stiffness" of the nuclei in the entrance channel. In this work, we explore its dependence on the total mass and the $Q$-value of the fusing systems and find that the fusion hindrance depends in a systematic way on the entrance channel properties over a wide range of systems.Comment: Submitted to Phys. Rev. Lett., 5 pages, 3 figure

The responsiveness of the action research arm test and the Fugl-Meyer Assessment scale in chronic stroke patients

The responsiveness of the Action Research Arm (ARA) test and the upper extremity motor section of the Fugl-Meyer Assessment (FMA) scale were compared in a cohort of 22 chronic stroke patients undergoing intensive forced use treatment aimed at improvement of upper extremity function. The cohort consisted of 13 men and 9 women, median age 58.5 years, median time since stroke 3.6 years. Responsiveness was defined as the sensitivity of an instrument to real change. Two baseline measurements were performed with a 2-week interval before the intervention, and a follow-up measurement after 2 weeks intensive forced use treatment. The limits of agreement, according to the Bland-Altman method, were computed as a measure of the test-retest reliability. Two different measures of responsiveness were compared: (i) the number of patients who improved more than the upper limit of agreement during the intervention; (ii) the responsiveness ratio. The limits of agreement, designating the interval comprising 95% of the differences between two measurements in a stable individual, were -5.7 to 6.2 and -5.0 to 6.6 for the ARA test and the FMA scale, respectively. The possible sum scores range from 0 to 57 (ARA) and from 0 to 66 (FMA). The number of patients who improved more than the upper limit were 12 (54.5%) and 2 (9.1%); and the responsiveness ratios were 2.03 and 0.41 for the ARA test and the FMA scale, respectively. These results strongly suggest that the ARA test is more responsive to improvement in upper extremity function than the FMA scale in chronic stroke patients undergoing forced use treatment

An Improved Quantum Molecular Dynamics Model and its Applications to Fusion Reaction near Barrier

An improved Quantum Molecular Dynamics model is proposed. By using this model, the properties of ground state of nuclei from $^{6}$Li to $^{208}$Pb can be described very well with one set of parameters. The fusion reactions for $^{40}$Ca+$^{90}$Zr, $^{40}$Ca+$^{96}$Zr and $^{48}$Ca+$^{90}$Zr at energy near barrier are studied by this model. The experimental data of the fusion cross sections for $^{40}$Ca+$^{90,96}$Zr at the energy near barrier can be reproduced remarkably well without introducing any new parameters. The mechanism for the enhancement of fusion probability for fusion reactions with neutron-rich projectile or target is analyzed.Comment: 20 pages, 12 figures, 3 table

Path integral approach to no-Coriolis approximation in heavy-ion collisions

We use the two time influence functional method of the path integral approach in order to reduce the dimension of the coupled-channels equations for heavy-ion reactions based on the no-Coriolis approximation. Our method is superior to other methods in that it easily enables us to study the cases where the initial spin of the colliding particle is not zero. It can also be easily applied to the cases where the internal degrees of freedom are not necessarily collective coordinates. We also clarify the underlying assumptions in our approach.Comment: 11 pages, Latex, Phys. Rev. C in pres

Long-term effect of comorbidity on the course of physical functioning in patients after stroke and with multiple sclerosis

OBJECTIVE: To study the effect of comorbidity on the course of physical functioning in patients after stroke and with multiple sclerosis. SUBJECTS: Patients after a first-ever supratentorial stroke (n = 198), who had been admitted for inpatient rehabilitaion, and patients with recently diagnosed multiple sclerosis (n =146). DESIGN: Prospective, observational study over a period of 3 years. MEASUREMENTS: Physical functioning was measured with the motor score of the Functional Independence Measure at baseline (time of diagnosis), and at 6 months, and 1 and 3 year follow-ups. Cardiovascular, respiratory, musculoskele nottal, diabetes mellitus, and other comorbidities were measured at baseline. RESULTS: Patients after stroke and multiple sclerosis with comorbidity showed a significantly lower level of physical functioning over all 4 measurements. There was no difference in the course of physical functioning between patients after stroke with and without comorbidity. In patients with multiple sclerosis, a greater decrease in physical functioning over the 3-year follow-up was found in patients with comorbidity of the musculoskeletal system compared with patients without. CONCLUSION: These findings indicate that similar improvements in physical functioning can be expected during rehabilitation of stroke patients with comorbidity compared with patients without these conditions. In patients with multiple sclerosis, musculoskeletal comorbidity requires further attention because of its association with a greater decrease in physical functionin

Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients

Background and Purpose - The Motor Activity Log (MAL) is a semistructured interview for hemiparetic stroke patients to assess the use of their paretic arm and hand (amount of use [AOU]) and quality of movement [QOM]) during activities of daily living. Scores range from 0 to 5. The following clinimetric properties of the MAL were quantified: internal consistency (Cronbach α), test-retest agreement (Bland and Altman method), cross-sectional construct validity (correlation between AOU and QOM and with the Action Research Arm (ARA] test), longitudinal construct validity (correlation of change on the MAL during the intervention with a global change rating [GCR] and with change on the ARA), and responsiveness (effect size). Methods - Two baseline measurements 2 weeks apart and 1 follow-up measurement immediately after 2 weeks of intensive exercise therapy either with or without immobilization of the unimpaired arm (forced use) were performed in 56 chronic stroke patients. Results - Internal consistency was high (AOU: a=0.88; QOM: a=0.91). The limits of agreement were -0.70 to 0.85 and -0.61 to 0.71 for AOU and QOM, respectively. The correlation with the ARA score (Spearman p) was 0.63 (AOU and QOM). However, the improvement on the MAL during the intervention was only weakly related to the GCR and to the improvement on the ARA, Spearman p was between 0.16 and 0.22. The responsiveness ratio was 1.9 (AOU) and 2.0 (QOM). Conclusion - The MAL is internally consistent and relatively stable in chronic stroke patients not undergoing an intervention. The cross-sectional construct validity of the MAL is reasonable, but the results raise doubt about its longitudinal construct validity