Reliability and validity of the Upper Limb Performance Assessment for functional prehension tasks in adults with stroke: A prospective study

Background Managing upper limb motor performance in daily living is a challenge for adults with stroke. Current assessments demonstrate limitations for evaluation of personalised activity performance in real environments. Objective To examine the reliability, validity, clinical utility and interpretability of a standardised ecologically task-based assessment of upper limb motor performance in post-stroke adults using the Upper Limb Performance Assessment. Design A prospective validation study. Setting A neurorehabilitation centre. Participants 100 adults with chronic post-stroke upper limb deficit. Performance was rated by three trained occupational therapists. Main measures Upper limb movement was analysed through Upper Limb Performance Assessment on a video-recorded prehension drinking task. Prehension was rated for reliability and measurement error with the intra-class correlation coefficient and the minimal difference. Validity was examined with the Fugl-Meyer Assessment for Upper Extremity, the Wolf Motor Function Test, the Motor Activity Log and the Functional Independence Measure according to Spearman's rank correlation coefficient. Results Reliability demonstrated adequate reliability metrics (intra-class correlation coefficient: 0.87–0.97) and measurement error (12.56%–15.99%) without systematic bias. Convergent validity was strong with the Fugl-Meyer Assessment (Spearman's rank correlation coefficient (ρ)= .76, p < .01), Wolf Motor Function Test (ρ= .72, p < .01), Motor Activity Log (ρ=.67, p < .05) and Functional Independence Measure (ρ=.58, p < .01). Clinical utility for administration time and costs was demonstrated. Conclusion The Upper Limb Performance Assessment demonstrated excellent reliability among trained raters, adequate convergent validity and interpretability in adults with stroke, demonstrating moderate clinical utility. It presents an interest as an observer-rated performance-based measure of functional prehension in real-life settings.