The Functional Test of the Hemiparetic Upper Extremity– A Rasch Analysis with Theoretical Implications

Publication date: Available online 21 April 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Veronica T. Rowe, Carolee J. Winstein, Steven L. Wolf, Michelle L. Woodbury
ObjectiveTo investigate the measurement properties of the Functional Test of the Hemiparetic Upper Extremity (FTHUE) and examine how its score may or may not inform design of a rehabilitation program.DesignThe FTHUE was recently used in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation Stroke (ICARE) Randomized Clinical Trial (RCT). This circumstance provided the opportunity to examine the psychometric properties of the FTHUE as it pertains to contemporary post-stroke rehabilitation and recovery models.SettingOutpatient rehabilitation clinicParticipants109 participants, aged 61.2 ± 13.5 years and 46 ± 20.3 days post-stroke with resultant hemiparesis in the upper extremityInterventionsNot applicableMain Outcome MeasuresDimensionality was examined with confirmatory factor analysis (CFA) and person and item measures were derived with Rasch item response analysis. Therapists' notes were also reviewed.ResultsThe CFA results support unidimensionality and 16/17 items fit the Rasch model. The Rasch person separation (2.17) and item separation (4.50) indices, ability strata (3.22), person reliability (0.82) and item reliability (0.95) indicate good measurement properties. Item difficulties ranked from -6.46 to 3.43 logits, however there was a substantial ceiling effect of person measures. Post-hoc examination of therapists' written observations indicated that the scoring criteria are not sensitive to the movement strategy used for task completion.ConclusionsThe FTHUE's item difficulty hierarchy indicated that scores adequately distinguished the ability to perform simple vs complex motor movements of functional tasks. However, the FTHUE scoring method did not allow inclusion of the type of movement strategy used to accomplish task items. Therefore, we suggest modifications to the FTHUE that would allow it to be used for collaborative treatment planning and align well with more contemporary perspectives on treatment theory.



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