Grade-4/5 motor activity log-Brazil for post-stroke individuals with a severely impaired upper limb: a validity, reliability and measurement error study

Gabriela da Silva Matuti; Juliana Firmo Dos Santos; Maria Liliane da Silva; Elaine Menezes de Oliveira; Adriana Cláudia Lunardi; Fedora Biney; Gitendra Uswatte; Edward Taub; Sandra Regina Alouche

doi:10.1080/09638288.2024.2305298

Grade-4/5 motor activity log-Brazil for post-stroke individuals with a severely impaired upper limb: a validity, reliability and measurement error study

Disabil Rehabil. 2024 Jan 24:1-9. doi: 10.1080/09638288.2024.2305298. Online ahead of print.

Authors

Gabriela da Silva Matuti¹, Juliana Firmo Dos Santos¹, Maria Liliane da Silva¹, Elaine Menezes de Oliveira¹, Adriana Cláudia Lunardi², Fedora Biney³, Gitendra Uswatte⁴, Edward Taub⁴, Sandra Regina Alouche²

Affiliations

¹ Physiotherapy Department of Associação de Assistência à Criança Deficiente, São Paulo, Brazil.
² Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
³ Department of Physical Medicine and Rehabilitation, University of AL at Birmingham, Birmingham, AL, USA.
⁴ Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.

PMID: 38265026
DOI: 10.1080/09638288.2024.2305298

Abstract

Purpose: This study examined the clinimetrics of the Brazilian-Portuguese translation of the Grade-4/5 Motor Activity Log (MAL 4/5), which assesses everyday use of the more affected upper-limb (UL) in stroke survivors with moderate/severe or severe motor impairment.

Materials and methods: The translated MAL 4/5 was administered to 47 stroke survivors with moderate/severe or severe UL motor impairment. Accelerometers were worn on participants' wrists for five days on average prior to the first assessment. Test-retest and inter-rater reliabilities were assessed using the intraclass correlation coefficient (ICC), internal consistency using Cronbach's α, and construct validity was tested with correlations with the accelerometry. The measurement error (SEM) and the minimal detectable change (MDC) were calculated.

Results: MAL4/5-Brazil's test-retest reliability (AOU: ICC = 0.84; QOU: ICC = 0.90), inter-rater reliability (AOU: ICC = 0.83; QOU: ICC = 0.91), internal consistency (Cronbach's α = 0.91 and 0.95 for AOU and QOU scales, respectively), the SEM and MDC were 0.3 and 0.8 points for the AOU subscale and 0.2 and 0.5 points for the QOU subscale, respectively. The construct validity (AOU scale: r = 0.67; QOU scale: r = 0.76) was high.

Conclusion: Grade-4/5 Motor Activity Log-Brazil is a reliable and valid instrument for assessing the more-affected UL use of stroke patients with moderate/severe or severe UL motor impairments.

Keywords: Stroke; activities of daily living; motor activity log; outcome assessment; upper limb.

Plain language summary

Reliability and concurrent validity of the Grade-4/5 MAL-Brazil were established in adults with hemiparesis moderate/severe or severe upper extremity post Stroke.The minimum detectable change for the Grade-4/5 MAL-Brazil was 0.8 points for the Amount of Use scale and 0.5 points for the Quality of Use scale.Data from the accelerometry supports the construct validity of this instrument.The assessment can now be used clinically and for research in adults with impairment upper extremity moderate/severe or severe post Stroke.