@article{3a24a7769b7848b6a6e288243208b2a0,
title = "Reducing the Number of Test Items of the Action Research Arm Test Poststroke: A Decision Tree Analysis✰",
abstract = "Objective: The present study aimed to create a shorter version of the Action Research Arm Test (ARAT) without compromising its measurement properties. Design: Secondary analysis of stroke recovery cohorts that used the ARAT to measure upper limb impairment. Setting: Rehabilitation centers. Participants: Patients with stroke from 5 different stroke recovery cohorts (N=1425). Interventions: Not applicable. Main Outcome Measures: A decision tree version of the ARAT (ARAT-DT) was developed using chi-square automated interaction detection. In an independent validation subset, criterion validity, agreement of ARAT-DT with original ARAT scores and score categories, and construct validity with the Fugl-Meyer Upper Extremity Scale score were determined. Results: In total, 3738 ARAT measurements were available involving 1425 subjects. Chi-square automated interaction detection analysis in the development subset (n=2803) revealed an optimized decision tree with a maximum of 4 consecutive items. In the validation data set (n=935), the ARAT-DT differed by a mean of 0.19 points (0.3% of the total scale) from the original ARAT scores (limits of agreement=−5.67 to 6.05). The ARAT-DT demonstrated excellent criterion validity with the original ARAT scores (intraclass correlation coefficient=0.99 and ρ=0.99) and scoring categories (κw=0.97). The ARAT-DT showed very good construct validity with the Fugl-Meyer Upper Extremity Scale (ρ=0.92). Conclusion: A decision tree version of the ARAT was developed, reducing the maximum number of items necessary for ARAT administration from 19 to 4. The scores produced by the decision tree had excellent criterion validity with original ARAT scores.",
keywords = "Decision trees, Outcome measurement, Rehabilitation, Stroke, Upper extremity",
author = "Zonjee, {V. J.} and Selles, {R. W.} and Roorda, {L. D.} and Nijland, {R. H.} and {van der Oest}, {M. J. W.} and Bosomworth, {H. J.} and {van Wijck}, F. and Meskers, {C. G. M.} and {van Schaik}, {S. M.} and {van den Berg-Vos}, {R. M.} and G. Kwakkel",
note = "Funding Information: Supported by the Stichting Kwaliteitsgelden Medisch Specialisten (SKMS, Grant No. 53070331). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The RATULS trial was funded by the National Institutes of Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 11/26/05). The EXPLICIT stroke trial was funded by the Netherlands Organisation for Health Research and Development (ZonMw Grant No. 89000001) and was supported by the European Research Council (ERC) under the European Union's Seventh Framework Programme (FP/2007-2013)/ERC Grant Agreement no. 291339-4D-EEG and grants awarded by the Dutch Brain Foundation. The PROFITS cohort study was funded by the Netherlands Organisation for Health Research and Development (ZonMw Grant No. 104003008). Funding Information: We thank Helen Rodgers, trial participants, trial investigators, staff at Newcastle University who assisted with conducting the trial, staff at RATULS NHS study centers, and the Data Monitoring and Ethics and Trial Steering Committee members for their contribution to the RATULS trial. Supported by the Stichting Kwaliteitsgelden Medisch Specialisten (SKMS, Grant No. 53070331). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The RATULS trial was funded by the National Institutes of Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 11/26/05). The EXPLICIT stroke trial was funded by the Netherlands Organisation for Health Research and Development (ZonMw Grant No. 89000001) and was supported by the European Research Council (ERC) under the European Union's Seventh Framework Programme (FP/2007-2013)/ERC Grant Agreement no. 291339-4D-EEG and grants awarded by the Dutch Brain Foundation. The PROFITS cohort study was funded by the Netherlands Organisation for Health Research and Development (ZonMw Grant No. 104003008). Publisher Copyright: {\textcopyright} 2022 American Congress of Rehabilitation Medicine",
year = "2022",
month = aug,
doi = "https://doi.org/10.1016/j.apmr.2021.12.011",
language = "English",
volume = "103",
pages = "1582--1591",
journal = "Archives of physical medicine and rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",
number = "8",
}