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

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

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

The 'reach' of Digital Language Archives: towards criteria for evaluation

Over the last decade, and with the help of digital media and technologies, archives (with the focus here on archives for endangered and minority languages) have extended their focus from preservation to also becoming facilities for dissemination. Their innovations have largely been on ‘discovery’: firstly by encouraging digitisation and inclusion of analogue and obscure materials, and by partnership with funding institutions to support the creation of new, ‘born digital’ language resources; and secondly through online provision of language resources via web catalogues driven by standardised metadata and in some cases providing enhanced discovery through web portals aggregating the holdings of multiple archives. These advances have increased the visibility, relevance and authority of archives for language-related disciplines and for language-speaker communities. This paper considers a broader set of parameters describing the ‘reach’ of archives, where ‘reach’ includes (a) archives’ understanding of their key audiences in order to provide appropriate services for them, e.g. identifying a range of relevant audiences, their languages of access, their varied technological and information literacies, interface design and usability; (b) discovery, drawing on the understandings of audiences in order to help them browse, navigate, search, identify and select their items of interest; (c) delivery, i.e. making available selected resources according to users’ preferences whether by download, view-in-browser, through apps or other means; (d) access management such that resource delivery follows depositors’ and communities’ preferences, and where users have ways of applying for and negotiating for access; (e) information accessibility, where the actual desired content is accessible to users, whether in terms of contextualisation or appropriate complexity, language, or modality; and finally (f) feedback channels, where users can utilise the archive to provide feedback to depositors or to enhance deposits with user-generated content. Through considering how a number of archives are providing such services, we can see their transition from repositories of memory to facilities for fostering participation and understanding

Low agreement between cardiologists diagnosing left ventricular hypertrophy in children with end-stage renal disease

Background: Monitoring of the appearance of left ventricular hypertrophy (LVH) by echocardiography is currently recommended for in the management of children with End-stage renal disease (ESRD). In order to investigate the validity of this method in ESRD children, we assessed the intra- and inter-observer reproducibility of the diagnosis LVH. Methods. Echocardiographic measurements in 92 children (0-18 years) with ESRD, made by original analysists, were reassessed offline, twice, by 3 independent observers. Smallest detectable changes (SDC) were calculated for continuous measurements of diastolic interventricular septum (IVSd), Left ventricle posterior wall thickness (LVPWd), Left ventricle end-diastolic diameter (LVEDd), and Left ventricle mass index (LVMI). Cohen's kappa was calculated to assess the reproducibility of LVH defined in two different ways. LVHWT was defined as Z-value of IVSd and/or LVPWd>2 and LVHMI was defined as LVMI> 103 g/m 2 for boys and >84 g/m2 for girls. Results: The intra-observer SDCs ranged from 1.6 to 1.7 mm, 2.0 to 2.6 mm and 17.7 to 30.5 g/m2 for IVSd, LVPWd and LVMI, respectively. The inter-observer SDCs were 2.6 mm, 2.9 mm and 24.6 g/m2 for IVSd, LVPWd and LVMI, respectively. Depending on the observer, the prevalence of LVHWT and LVHMI ranged from 2 to 30% and from 8 to 25%, respectively. Kappas ranged from 0.4 to 1.0 and from 0.1 to 0.5, for intra-and inter- observer reproducibility, respectively. Conclusions: Changes in diastolic wall thickness of less than 1.6 mm or LVMI less than 17.7 g/m2 cannot be distinguished from measurement error in individual children, even when measured by the same observer. This limits the use of echocardiography to detect changes in wall thickness in children with ESRD in routine practice

Magnetotransport Mechanisms in Strongly Underdoped YBa_2Cu_3O_x Single Crystals

We report magnetoresistivity measurements on strongly underdoped YBa_2Cu_3O_x (x=6.25, 6.36) single crystals in applied magnetic fields H || c-axis. We identify two different contributions to both in-plane and out-of-plane magnetoresistivities. The first contribution has the same sign as the temperature coefficient of the resistivity \partial ln(\rho_i)/\partial T (i={c,ab}). This contribution reflects the incoherent nature of the out-of-plane transport. The second contribution is positive, quadratic in field, with an onset temperature that correlates to the antiferromagnetic ordering.Comment: 4 pages, 3 figure

Models for Enhanced Absorption in Inhomogeneous Superconductors

We discuss the low-frequency absorption arising from quenched inhomogeneity in the superfluid density rho_s of a model superconductor. Such inhomogeneities may arise in a high-T_c superconductor from a wide variety of sources, including quenched random disorder and static charge density waves such as stripes. Using standard classical methods for treating randomly inhomogeneous media, we show that both mechanisms produce additional absorption at finite frequencies. For a two-fluid model with weak mean-square fluctuations <(d rho_s)^2 > in rho_s and a frequency-independent quasiparticle conductivity, the extra absorption has oscillator strength proportional to the quantity <(d rho_s)^2>/rho_s, as observed in some experiments. Similar behavior is found in a two-fluid model with anticorrelated fluctuations in the superfluid and normal fluid densities. The extra absorption typically occurs as a Lorentzian centered at zero frequency. We present simple model calculations for this extra absorption under conditions of both weak and strong fluctuations. The relation between our results and other model calculations is briefly discussed