Ïã¸ÛÁùºÏ²Ê¼´Ê±¿ª½±

Chronic Stroke: (Fayazi, Dehkord, Dadgoo, & Salehi, 2012; n = 20; age range = 37 to 76; time post stroke range = 3 months to 4 years; male = 10; female = 10)

• SEM for entire group (n = 20): 4.66

Chronic Stroke: calculated using SEM from (Fayazi et al., 2012)

• MDC: 12.92

MCID is not reported in the literature.

Upper Extremity Hemiparesis: (Sunderland, Tinson, Bradley, & Hewer, 1989; n = 38; age range = 31 to 82; average age = 67; left arm affected, n = 21; right arm affected = 17; MCA stroke, n = 36; brainstem stroke, n = 2)

• 1 month cut-off scores > 18 indicates a score above zero on Frenchay Arm Test at 6 months, measuring functional use of affected limb

Acute/Chronic Stroke: (Demeurisse, Demol, & Robaye, 1980; n = 100; measured at 11 days, 2, 4 and 6 months post stroke; mean age (total) = 69, 59 men, mean age = 67; 41 women, mean age = 71; left side hemiplegia = 36, right side hemiplegia = 64)

*Authors do not report the normative data, but the measure and subsequent norms were developed using this population

Subacute/Chronic Stroke: (Collin & Wade, 1990; n = 36; weeks post stroke = 6 (27 weeks), 12 (25 weeks); 18 (14 weeks); age range (male) = 15 to 77; mean age (male) = 56.1; age range (female) = 45-69; mean age (female) = 59.9; right side hemiplegia = 21)

• Observer 1 upper extremity (SD): 30 (36)

• Observer 2 upper extremity (SD): 31 (39)

Acute/Subacute Stroke: (Bohannon, 1999; n = 15; age range = 46 to 81; mean age = 66.7; within 15 days of onset; no comorbidities affecting upper extremity)

• Pinch-grasp mean, median, range score: 15.2; 20.5; 0-33.0

• Elbow flexion mean, median, range score: 19.7; 25.0; 0-33.0

• Shoulder abduction mean, median, range score: 18.7; 22.0; 0-33.0

• Total motricity mean, median, range score: 54.6; 70.5; 1-100.0

Acute/Chronic Stroke: (Hsieh et al., 1998; n = 50; mean age = 65; male = 30; female = 20; median, range days post onset = 55 (8-535); subarachnoid hemorrhage = 7; cerebral hemorrhage = 13; cerebral infarction = 21; other = 9; right-sided paresis = 22; left-sided paresis = 23; bilateral paresis = 5)

• Mean score for total upper extremity motricity: 46.2 (31.9)

Subacute/Chronic Stroke: (Jacob-Lloyd, Dunn, Brain, & Lamb, 2005; upper extremity n = 22; age > 60 years, n = 85%(of total study n = 55); assessed average of 76 days post onset and 6 months + 76 days (average) post onset)

• Discharge (average 76 days post onset) median: 77

• Discharge (average 76 days post onset) IQR: 77-84

• 6 month post discharge median: 100

• 6 month post discharge IQR: 77-100

Lower Extremity:

Subacute/Chronic Stroke: (Collin & Wade, 1990)

• Observer 1 lower extremity (SD): 52 (20)

• Observer 2 lower extremity (SD): 55 (22)

Subacute/Chronic Stroke: (Jacob-Lloyd et al., 2005)

• Discharge (average 76 days post onset) median: 76

• Discharge (average 76 days post onset) IQR: 52-94

• 6 month post discharge median: 76

• 6 month post discharge IQR: 48-100

Subacute Stroke: (Cameron & Bohannon, 1999; n = 15; age range = 29 to 77; mean age = 53.7; male = 11; female = 4; left-sided hemiparesis = 8; right-sided hemiparesis = 7)

• Hip flexion mean: 20.3

• Hip flexion standard deviation: 6.5

• Hip flexion range: 9-33

• Knee extension mean: 21.2

• Knee extension standard deviation: 7.7

• Knee extension range: 0-33

• Ankle dorsiflexion mean: 11.7

• Ankle dorsiflexion standard deviation: 10.6

• Ankle dorsiflexion range: 0-33

• All mean: 54.3

• All standard deviation: 20.9

• All range: 10-100

Chronic: (Fayazi et al., 2012)

• Mean score at week 1 (SD): 58.20 (17.683)

• Mean score at week 2 (SD): 56.60 (19.632)

Chronic Stroke: (Fayazi et al., 2012)

• Excellent test-retest reliability: (ICC = .93)

Subacute/Chronic Stroke: (Collin & Wade, 1990)

• Excellent interrater reliability: MI arm (Spearman¡¯s rho = .88, p < 0.001)

• Excellent interrater reliability: MI leg (Spearman¡¯s rho = .87, p < 0.001)

• Excellent interrater reliability: MI side (Spearman¡¯s rho = .88, p < 0.001)

Chronic Stroke: (Fayazi et al., 2012)

• Excellent intra-rater reliability (ICC = 0.93, 95% CI = 0.84-0.97, p < 0.001)

Normative Sample: (Haley et al., 1992; n = 412)

• Excellent: Cronbach's alpha = .95-.99*

*Scores > .9 may indicate redundancy in scale questions.

Acute Stroke: (Cameron & Bohannon, 2000; n = 15)

• Adequate: Cronbach ¦Á of lower extremity = .77

• Upper extremity = unknown

Predictive validity

Subacute/Chronic Stroke: (Collin and Wade, 1990)

• Excellent predictive validity of MI score at 6 weeks and walking ability at 18 weeks

Upper Extremity Hemiparesis: (Sunderland et al., 1989)

• Cut off scores on Motricity Index at 1 month were best predictor of functional outcomes at 6 months when compared with percentage grip, the Motor Club Assessment, Frenchay Arm Test, and the 9-Hole Peg Test (Sunderland et al., 1989)

Subacute/Chronic Stroke: (Collin & Wade, 1980)

• At 6 weeks post stroke, lower scores on the MI-Leg combined with the Trunk Control Test predicted failure to walk by 18 weeks.

One Year or More Post Stroke: (Kong et al., 2011; n = 140; mean age = 61.0 (13.3); male, n = 88; UE MI mean = 21.0 (25.9); LE MI mean = 29.8 (27.2); Modified Barthel Index mean = 42.8 (26.3); Dysphasia, n = 37; Neglect, n = 32; Sensory impairment, n = 80)

• Only 28.3% gained upper limb dexterity post stroke

• Sensory impairment, severe spasticity and low scores on MAS, UEMI and LEMI were significantly correlated to poor dexterous function

• Severe spasticity was correlated with low UEMI score and poor dexterity

• Poor dexterous function was predicted by a severe stroke, neglect, sensory impairment, total/partial anterior circulation stroke and low MBI, UEMI and LEMI scores on rehabilitation admission

• The most important predictor of dexterity was the UEMI score on admission to rehabilitation

• The ability to do a pin grip at admission to acute rehabilitation was a predictor of recovering UE dexterity ( e.g. the probability of regaining dexterity was 3.4% in patients with absent pinch group but 80% in those with MI scores of 22 or higher)

Factors correlating MI scores to Upper Limb Dexterity

Stroke: (Bland et al., 2012; two samples of patients in an inpatient rehabilitation facility unit (n = 110 and 159; mean age 62 (14) and 63 (15), respectively)

• Admission Lower extremity MI was 65 (26) and 59 (30), respectively in patients subacute post stroke

• Adequate correlation between Lower Extremity MI at admission and speed of 10-meter walk speed at discharge (r = 0.47)

• The lower extremity MI did not explain a significant amount of the variance in walking speed at discharge nor differentiate household versus community.

Ischemic or Hemorrhagic Stroke: (Aufman et al., 2013; n = 198; mean age of nondrivers = 64.1 (¡À 14.0); mean age of nonreturners = 59.9 (¡À13); mean age of returners = 61.5 (¡À 13.7))

• LEMI and FIM-C explained 30% of the variance in patients who returned to driving at six months post-stroke.

Acute Stroke: (Cameron & Bohannon, 2000)

• Excellent predictive validity of dynamometer measurements and MI arm scores (r = 0.78)

• Excellent predictive validity of dynamometer measurements and MI leg scores (r = 0.91)

Concurrent validity

Stroke: (Arwert et al, 2016; n = 51; average time since stroke = 8 months (3-27 months); female, n = 16)

• Excellent concurrent validity between the MHQ and the Arm MI for all patients (r = 0.78)

• Average concurrent validity between the MHQ and the Arm MI for patients with less than 100 on the Arm MI (r = 0.65)

• Average to Excellent concurrent validity between Arm MI and functional subscales of the MHQ

Upper Extremity: (Sunderland et al., 1989)

• When comparing the 9 Hole Peg Test, Motor Club Impairment, Frenchay Arm Test and MI Arm Score, the MI Arm test was the most sensitive measure in detecting early change

Stroke: (Bohannon, 1999)

• Excellent concurrent validity between dynamometry measurements of the upper extremity and the MI Arm Score (r = 0.89; p<0.001)

Acute Stroke: (Cameron & Bohannon , 2000), (Bohannon, 1999), (Sunderland et al., 1989)

• Excellent concurrent validity between dynamometry measurements and Leg MI

  • Hip Flexion (r = .85)

  • Knee Extension (r = .83)

  • Ankle Dorsiflexion (r = .89)

  • All (r = .78)

• Excellent concurrent validity between dynamometry measurements and Arm MI

  • MI Pinch Grasp and Dynamometry Hand Grasp (r = .81)

  • Elbow Flexion (r = .87)

  • Shoulder Abduction (r = .80)

  • All (r = 0.91)

Subacute/Chronic Stroke: (Collin & Wade, 1990)

• Excellent concurrent validity between the Rivermead Motor Assessment and the MI

* p < 0.001; ** p < 0.01

Post Stroke Hemiplegia: (Lu et al., 2015; n = 22; mean age = 54.8 (8.5); male, n = 18; able to walk independently; mean Leg MI score = 70.4 (21.5); Chinese sample)

• Adequate concurrent validity of the Wisconsin Gait Scale (WGS) with the MI (r = -0.687; p < 0.01)

• Excellent concurrent validity of the Gait Abnormality Rating Scale (GARS) with the MI (r = -0.742; p < 0.01)

Within 6 Months Post Stroke: (Meyer et al., 2015; n = 122; males, n = 77; mean post stroke time = 82 days; average age = 67 (58.8-76.1; Belgian sample)

• Upper limb somatosensory impairments were common, with prevalence rates 21%- 54%

• Poor to Adequate concurrent validity between somatosensory deficits and MI scores for the UE (r =  -0.56 to 0.35)

• Poor to Adequate concurrent validity between somatosensory and motor deficits (r = 0.22-0.61)

• There were consistently stronger correlations between motor and somatosensory deficits in patients with visuospatial neglect ( r = 0.44-0.78) compared to patients without neglect (r = 0.08-0.59)

• The MI median (interquartile range) was 67.5 for patients overall and 23 (0-83) for those with Neglect and 76 for patients without neglect (p < 0.02)

Em-NSA = Erasmus MC modification of the revised Nottingham Sensory Assessment; TFT = Thumb Finding Test; Statistically significant adequate correlations

Ischemic or Hemmorhagic Stroke: (Bertrand et al., 2015; n = 34)

Participants were recruited from an acute neurology ward after their first stroke, and were administered the MI Arm, Chedoke Arm and Hand Activity Inventory (CAHAI), and the ABILHAND questionnaire.

• Excellent concurrent validity between the MI Arm and the CAHAI at weeks 2, 4, 8, and 12 (r = 0.87-0.94)

• Excellent concurrent validity between the MI Arm at weeks 1, 2, 4, 8, and 12 and the ABILHAND at week 12 (r = 0.69-0.82)

Subacute/Chronic Stroke: (Collin & Wade ,1990)

• Excellent convergent validity of the MI arm score and the MI leg score with the Rivermead Motor Assessment

**p < 0.001; *p < 0.01; RMA = Rivermead Motor Assessment; MI = Motricity Index

When the Motricity Index was initially developed, Demeurisse et al. (1980, p. 388) applied a Hotelling¡¯s analysis and determined that, ¡°because of the nearness of these coefficients, the sum of the values of the six items in question is a good measurement of analytical motricity.¡±

Content validity was not discussed in the literature. The Motricity Index, however, is often used when examining validity, reliability and responsiveness of other rehab measures (Wade, 1988; Benaim et al., 1999; Bertrand et al., 2015)

Upper Extremity:

• Adequate ceiling effects: 100% of participants scored above midpoint; 18% gained maximum score (Jacob-Lloyd et al., 2005)

• A comparison of grip strength among the Frenchay Arm Test, the Motor Club, the 9-Hole Peg Test and the MI revealed floor effects on admission for the Frenchay and Peg Test, yet the MI demonstrated 57% of patients had measurable pinch grip within first 3 weeks of stroke; only 2% had normal pinch grip (Sunderland et al., 1989).

• When all patients were examined 0% showed a floor effect and 28% showed a ceiling effect with respect to the MI Arm.

• In the subgroup with MI Arm score <100, 0% of patients had a floor or ceiling effect (Arwert et al., 2016)

Lower Extremity:

• Poor ceiling effects: 76% of participants scored at or above midpoint; 24% gained maximum score (Jacob-Lloyd et al., 2005)

Upper Extremity:

• Large responsiveness (ES = 0.91, Z = 5.45, p < 0.001) to detecting changes < 3 months after stroke. Measurements were done within the first 72h of admission and on the last day of hospital stay (Safaz et al., 2009).

• Increase observed for MI tests administered 6 weeks apart, but no statistical measure noted (Collin & Wade, 1990)

• Moderate sensitivity to detecting change < 3 months after stroke (Effect Size = .70) (Sunderland et al., 1989; n = 31; assessed at initial-1 month; 1-3 months)

• Small sensitivity to detecting change > 3 months after stroke (Effect size = .29) (Sunderland et al., 1989; n = 31; assessed at 3-6 months)

Lower Extremity:

• Small sensitivity to detecting change in the acute phase. Mean number of days between tests = 9.6 days (effect size = .30; SRM = 1.0) (Vos-Vromans et al., 2005).