Clinical interpretation and cutoff scores for manual ability measured by the ABILHAND questionnaire in people with stroke

Figures & data

Figure 1. Flow chart of inclusion.

Table 1. Definitions of the cutoffs categories.

Scale	Range	Cutoffs categories
ARAT	0-10	No capacity (35,36)	No dexterity (34)	Low
	11-20	Poor capacity (35,36)	Some dexterity (34)
	22-42	Limited capacity (35,36)		Good
	43-54	Notable capacity (35,36)
	55-57	Full capacity (35,36)
FMA-UE	0-22	Optimal scores associated with ARAT capacity levels shown above (36)	Severe (37-41)	Low (17)
	23-31
	32-47		Moderate to Mild (37-41)	Good (17)
	48-52
	53-66
SIS-Hand	0-24	2 sub-categories at low level		Low
	25-49
	50-74	2 sub-categories at good level		Good
	75-100

Abbreviations: ARAT: Action Research Arm Test; FMA-UE: Fugl-Meyer Assessment for Upper Extremity; SIS Hand: Stroke Impact Scale subscale hand

Table 2. Demographic and clinical characteristics (n = 80).

Characteristics
Age, mean years (SD; range)	68 (13; 34 to 90)
Gender (female), n (%)	32 (40)
Stroke type, n (%)
Ischemic	65 (81)
Hemorrhagic	15 (19)
Paretic arm (right), n (%)	34 (43)
Affected side (dominant), n (%)	35 (44)
NIHSS at onset (stroke severity)
Mild (< 5), n (%)	33 (41)
Moderate (5 to 14), n (%)	35 (44)
Severe (>14), n (%)	12 (15)
mRS at discharge from acute care (global disability)
Slight (score 2), n (%)	12 (15)
Moderate (score 3), n (%)	30 (37.5)
Moderately severe (score 4), n (%)	38 (47.5)
UE disability at 3 months after stroke
ABILHAND, mean (SD)	2.75 (2.90)
SIS Hand, mean (SD)/median (IQR)	56.3 (40.0)/70 (0 to 95)
ARAT, mean (SD)/median (IQR)	41.2 (22.9)/56 (13.5 to 57)
FMA-UE, mean (SD)/median (IQR)	48.2 (22.4)/61 (28.2 to 65)

Abbreviations: NIHSS: the National Institutes of Health Stroke Scale; mRS: the Modified Rankin Scale; ABILHAND logit scale (measurement range of approx. 10 logits); SIS Hand: Stroke Impact Scale subscale hand (score range 0 to 100); ARAT: Action Research Arm Test (score range 0 to 57); FMA-UE: Fugl-Meyer Assessment for Upper Extremity (score range 0 to 66)

Table 3. ABILHAND cutoff scores according to UE functioning categories of SIS hand, ARAT, and FMA-UE (n = 80).

Cut-off levels	AH cut-off	Sens	Spec	AUC (95% CI)	p-value
Low and Good
SIS Hand ≥ 50	1.78	0.960	0.933	0.980 (0.954 - 1.000)	< 0.001
ARAT ≥ 22	1.78	0.833	1.000	0.941 (0.892 - 0.990)	< 0.001
FMA-UE ≥ 32	1.78	0.833	1.000	0.941 (0.892 – 0.990)	< 0.001
Other cutoffs
SIS Hand
SIS Hand > 0	1.41	0.898	1.000	0.971 (0.939 – 1.000)	< 0.001
SIS Hand ≥ 25	1.78	0.875	0.958	0.957 (0.916 – 0.998)	< 0.001
SIS Hand ≥ 75	3.54	0.846	0.929	0.947 (0.903 – 0.992)	< 0.001
SIS Hand < 100	5.61	0.868	0.750	0.857 (0.759 – 0.956)	< 0.001
ARAT
ARAT > 0	1.41	0.726	1.000	0.902 (0.814 – 0.990)	< 0.001
ARAT ≥ 11	1.78	0.833	1.000	0.941 (0.892 – 0.990)	< 0.001
ARAT ≥ 43	2.19	0.855	0.960	0.948 (0.899 – 0.996)	< 0.001
ARAT ≥ 55	2.31	0.932	0.833	0.941 (0.893 – 0.990)	< 0.001
ARAT < 57	2.87	0.800	0.914	0.928 (0.876 – 0.980)	< 0.001
FMA-UE
FMA-UE > 4	0.47	0.792	1.000	0.898 (0.790 – 1.000)	< 0.001
FMA-UE ≥ 23	1.78	0.806	1.000	0.930 (0.877 – 0.983)	< 0.001
FMA-UE ≥ 48	2.31	0.836	0.960	0.943 (0.904 – 0.994)	< 0.001
FMA-UE ≥ 53	2.31	0.882	0.931	0.958 (0.920 – 0.966)	< 0.001
FMA-UE < 66	4.28	0.803	0.789	0.832 (0.732 – 0.933)	< 0.001

Abbreviations: AH: ABILHAND logit scale (measurement range of approx. 12 logits); Sens: sensitivity; Spec: specificity; AUC: Area Under the Curve; SIS Hand: Stroke Impact Scale subscale hand (score range 0 to 100); ARAT: Action Research Arm Test (score range 0 to 57); Fugl-Meyer Assessment for Upper Extremity (score range 0 to 66), score range in study sample 4 to 66.

Figure 2. Scatterplot of perceived manual ability assessed by SIS Hand (Stroke Impact Scale subscale hand, score range 0 to 100, cutoff score 50) and ABILHAND logit scale (measurement range of approx. 10 logits, cutoff score 1.78) (n = 80).

Figure 3. Scatterplot of observed activity capacity assessed by ARAT (Action Research Arm Test, score range 0 to 57, cutoff score 22) and perceived manual ability assessed by ABILHAND logit scale (measurement range of approx. 10 logits, cutoff score 1.78) (n = 80).

Figure 4. Scatterplot of observed function assessed by FMA-UE (Fugl-Meyer Assessment for Upper Extremity (score range 0 to 66, cutoff score 32) and perceived manual ability assessed by ABILHAND logit scale (measurement range of approx. 10 logits, cutoff score 1.78) (n = 80).

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Data availability statement

Interested researchers may submit requests for data to the authors (contact [email protected]). According to the Swedish regulation (http://www.epn.se/en/start/regulations/), the permission to use data is only for what has been applied for and then approved by the ethical board.