Comparison of the action research arm test and the Fugl-Meyer assessment as measures of upper-extremity motor weakness after stroke

OBJECTIVE: To assess the relative responsiveness of 2 commonly used upper-extremity motor scales, the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA), in evaluating recovery of upper-extremity function after an acute stroke in patients undergoing inpatient rehabilitation. DESIGN: Prospective. SETTING: An acute stroke rehabilitation unit. PARTICIPANTS: One hundred four consecutive admissions (43 men, 61 women; mean age +/- standard deviation, 72+/-13y) to a rehabilitation unit 16+/-9 days after acute stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The following assessments were completed within 72 hours of admission and 24 hours before discharge: ARAT, upper-extremity motor domain of the FMA, National Institutes of Health Stroke Scale, FIM instrument total score, and FIM activities of daily living (FIM-ADL) subscore. RESULTS: The Spearman rank correlation statistic indicated that the 2 upper-limb motor scales (ARAT, FMA) correlated highly with one another, both on admission (rho = .77, P < .001) and on discharge (rho = .87, P < .001). The mean change in score from admission to discharge was 10+/-15 for the ARAT and 10+/-13 for the FMA motor score. The responsiveness to change as measured by the standard response mean was .68 for the ARAT and .74 for the FMA motor score. The Spearman rank correlation of each upper-limb motor scale with the FIM-ADL at the time of admission was as follows: ARAT, rho equal to .32 (P < .001) and FMA motor score, rho equal to .54 (P < .001). CONCLUSIONS: Both the FMA motor score and the ARAT were equally sensitive to change during inpatient acute rehabilitation and could be routinely used to measure recovery of upper-extremity motor function.