The MAL is a semi-structured interview to assess arm function.
30, 28, or 14
20 minutes
Adult
18 - 64
yearsElderly Adult
65 +
yearsInitially reviewed by Jane Sullivan, PT in 2013. Updated by Maggie Bland PT,DPT,NCS and Nancy Byl PT,MPH,PhD, FAPTA and the StrokEDGE II task force of the Neurology Section of the APTA in 2016.
Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
For detailed information about how recommendations were made, please visit:
Abbreviations: |
|
HR | Highly Recommend |
R | Recommend |
LS / UR | Reasonable to use, but limited study in target group / Unable to Recommend |
NR | Not Recommended |
Recommendations for use based on acuity level of the patient:
| Acute (CVA < 2 months post) (SCI < 1 month post) (Vestibular < 6 weeks post) | Subacute (CVA 2 to 6 months) (SCI 3 to 6 months) | Chronic (> 6 months) |
StrokEDGE | NR | HR | HR |
Recommendations based on level of care in which the assessment is taken:
| Acute Care | Inpatient Rehabilitation | Skilled Nursing Facility | Outpatient Rehabilitation | Home Health |
StrokEDGE | NR | NR | NR | UR | UR |
Recommendations for entry-level physical therapy education and use in research:
| Students should learn to administer this tool? (Y/N) | Students should be exposed to tool? (Y/N) | Appropriate for use in intervention research studies? (Y/N) | Is additional research warranted for this tool (Y/N) |
StrokEDGE | No | Yes | Yes | Yes; there are no studies on content or construct validity |
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(Simpson, 2015; systematic review of articles for patients post stroke)4
MDC95 = 0.67- 1.27
Stroke:
(Van der Lee JH et al, 2004; n = 56 chronic stroke patients)
(Uswatte G et al, 2006; n = 41 chronic stroke patients complete MALs before and after CI therapy or a placebo control; n = 27 in second study for chronic stroke patients who complete MALs and wore accelerometers that monitored their arm movements for 3 days outside the laboratory before and after an automated form of CI therapy)
Stroke:
(Van der Lee JH et al, 2004)
(Uswatte G et al, 2006)
Stroke:
(Uswatte G et al, 2005)
(Uswatte G et al, 2005; n = 106 post stroke patients with mild to moderate paresis of upper extremity who took MAL before and after treatment; n = 116 took MAL an equivalent no-treatment period)
| Pre-Intervention (95% CI) | Post-Intervention (95% CI) | ||
| Modified Nottingham Extended Scale | Frenchay Activities Index | Modified Nottingham Extended Scale | Frenchay Activities Index |
MAL AOU (30) | 0.3 (0.1-0.5) | 0.3 (0.1-0.5) | 0.3 (0.1-0.5) | 0.4 (0.2-0.6) |
MAL QOL (3) | 0.3 (0.1-0.5) | 0.3 (0.1-0.5) | 0.2 (0-0.4) | 0.3 (0.1-0.5) |
Stroke:
(Van Der Le JH et al, 2004)
(Unswatte G et al, 2005)
In this systematic review across 68 studies, the effect size for Patient perception of change (MAL) were 1.6 to 6.2 (mean 1.66) larger than lab-based functional performance measures (ARAT or Wolf)4
Effect sizes were larger with greater variance for patients 1-2 months post stroke versus patients > 3 months post stroke
Effect sizes were larger for patients with less severe impairments at 1-2 months post stroke.
Effect sizes calculated based on change score divided by baseline standard deviation (population effect size) were lower than standardized response mean (based on change score divided by the change score standard deviation) for the same measure.
(Hammer and Lindmark, 2010)
Effect Size: .51 MAL-AOU and .54 MAL-QOM during intervention and 1.02 MAL-AOU and 1.17 MAL-QOM pre intervention to 3 mo F/U5
SRM: 1.28 MAL-AOU and 1.03 MAL QOM during intervention and 1.14 MAL-AOU and 1.19 MAL-QOM 3 mo after treatment
RR: 1.22 MAL-AOU and 1.23 MAL-QOM during intervention and 2.44 MAL-AOU and 2.69 MAL-QOM 3 month after treatment
Hammer AM, Lindmark B. Responsiveness and vaidity of the Motor Activity og in patients during the subacute phase after stroke Disability and Rehabilitation 2010; 32 (14):1184-1193
Lin K-c, Chuang L-l, Wu C-y, Hsieh Y-w. Responsiveness and validity of three dexterous function measures in stroke rehabilitation. J of Rehabilitation Research and Development: 2010;47 (4): 563-572
Lin K-C, Fu T Wu C-Y, Hsieh Y-W, Chen C-L, Lee P-C. Psychometric comparisons of the Stroke Impact Scale 3.0 and Stroke-Specific Quality of Liv Scale. Research 2010; 29 (3):435-443
Simpson LA, Eng JJ Functional recovery following stroke: Capturing changes in upper extremity function Neurorehabil Neural Repair 2013: 240-250.
Uswatte, G., Taub, E., et al. (2006). "The Motor Activity Log-28 Assessing daily use of the hemiparetic arm after stroke." Neurology 67(7): 1189-1194.
Uswatte, G., Taub, E., et al. (2005). "Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use." Stroke 36(11): 2493-2496.
Van der Lee, J., Beckerman, H., et al. (2004). "Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients." Stroke 35(6): 1410-1414.
Wu C-y,Chuang L-l Lin K-c, Horng Y-s. Responsiveness and validity of two outcome measures of instrumental activities of daily living in stroke survivors receiving rehabilitative therapies.Clinical Rehabilitation 2011; 26:176-183
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.