Abstract
ObjectiveTo develop a brief, valid and reliable tool [the Rating of Everyday Arm-use in the Community and Home (REACH) scale] to classify affected upper limb use after stroke outside the clinical setting.MethodsFocus groups with clinicians, patients and caregivers (n = 33) and a literature review were employed to develop the REACH scale. A sample of community-dwelling individuals with stroke was used to assess the validity (n = 96) and inter-rater reliability (n = 73) of the new scale.ResultsThe REACH consists of separate scales for dominant and non-dominant affected upper limbs, and takes five minutes to administer. Each scale consists of six categories that capture ‘no use’ to ‘full use’. The intraclass correlation coefficient and weighted kappa for inter-rater reliability were 0.97 (95% confidence interval: 0.95–0.98) and 0.91 (0.89–0.93) respectively. REACH scores correlated with external measures of upper extremity use, function and impairment (rho = 0.64–0.94).ConclusionsThe REACH scale is a reliable, quick-to-administer tool that has strong relationships to other measures of upper limb use, function and impairment. By providing a rich description of how the affected upper limb is used outside of the clinical setting, the REACH scale fills an important gap among current measures of upper limb use and is useful for understanding the long term effects of stroke rehabilitation.
Highlights
Measurement of functional recovery following stroke is an important aspect in the assessment of stroke care
Development of the REACH Scale The multiphase process which consisted of focus groups, literature review, feedback consultations and preliminary testing on individuals with stroke resulted in the development of the final REACH scale
The REACH scale consists of two separate classifications scales for people who had their dominant (Figure 1) and non-dominant side (Figure 2) affected by the stroke
Summary
Measurement of functional recovery following stroke is an important aspect in the assessment of stroke care. It is critical to determine whether patients incorporate the functional improvements they gained over rehabilitation into their daily lives; otherwise, any gains made may be lost. This ‘‘use it or lose it’’ phenomenon is evident following motor rehabilitation of the upper extremity (UE) following stroke [1]. While large MAL scores indicate greater quantity and quality of affected arm use, the scores do not inform clinicians how patients are using their upper limb in daily living (e.g., uses hand only for stabilisation, and not manipulation). Accelerometry, which measures the quantity of affected arm use, does not capture the type of activity the arm or hand is performing
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