gms | German Medical Science

Background: Stroke is a major health problem and a significant group of patients will experience upper limb hemiparesis [1]. The Action Research Arm Test (ARAT) is the recommended tool [2] to assess and identify changes in upper limb function during rehabilitation. Relevant literature did not include a representative sample and did not look at the difference in responsiveness to change between two treatment groups, receiving treatment at two different time points.

Aim: To compare the responsiveness to change of the ARAT in acute stroke patients between the early treatment group and the late treatment group.

Method: We used a secondary analysis based on a feasibility RCT that compared the responsiveness to change for the ARAT in two different treatment groups. Participants were divided over an early-, late- and usual-care treatment group. Augmented upper limb physiotherapy combined with normal upper limb physiotherapy was provided three weeks post stroke in the early group and compared with the same treatment nine weeks post stroke in the late group. The ARAT was conducted prior and post treatment. Responsiveness to change was expressed as the Standardised Response Mean (SRM).

Results/findings: 61 participants were recruited of whom 27 were included in this analysis omitting the usual care group. The interquartile range of ARAT scores was between 3 and 57 for the early group and between 3.5 and 57 for the late group. The SRM score for the early group (N=11) was 0.72, whereas this was 0.76 for the late group (N=16).

Discussion and conclusions: The results suggest a moderate to large responsiveness to change in the early treatment group and a small to moderate responsiveness to change in the late treatment group [3]. However, the findings indicate the need for a measure of responsiveness that is appropriate for skewed data.