Establishing levels of arm–hand activities in stroke patients: the arm-hand-activities-scale (AHAS)

Objective: Post-stroke limitations in arm–hand activities are prevalent, yet a system for categorizing these limitations like the Functional Ambulation Categories (FAC) is lacking. The Arm-Hand-Activities-Scale (AHAS) was developed and psychometric properties of this classification were investigated. Design: Mixed methods to examine comprehensibility, inter-rater reliability, correlations with the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT), and sensitivity to change. Subjects/Patients: 76 professionals answered a comprehensibility questionnaire and 85 professionals an inter-rater reliability questionnaire. Methods: For comprehensibility and inter-rater reliability, standardized video sequences of each category were assessed. Cut-off values were identified by comparing the AHAS categories with the FMA (n = 10) and the ARAT (n = 71). For sensitivity-to-change studies, 71 stroke patients were followed for 4 weeks of inpatient rehabilitation. Spearman correlation coefficients were calculated to examine the relationship between AHAS, FMA, and ARAT outcomes. A Wilcoxon signed-rank test was applied for sensitivity to change. Results: The results on comprehensibility of the AHAS categories and the FMA cutoff values were highly consistent. Inter-rater reliability was good to excellent. A significant and strong correlation was found between ARAT and AHAS. The Wilcoxon signed-rank test for sensitivity to change was also significant. Conclusion: The AHAS provides a quick and simple classification system to assess the severity of arm–hand activity limitations after stroke This may help in selecting appropriate treatment strategies.