Task and ecologically based assessment of upper-limb passive function before and after botulinum injections in adults with stroke using the Upper-Limb Performance Assessment: French cross-cultural adaptation and feasibility pilot study

Abstract

Purpose

To test feasibility of a French translation and cross-cultural adaptation of the Upper-Limb Performance Assessment (ULPA) for task and ecologically based assessment of individualized passive function of upper-limb (UL) performance in adults treated with botulinum toxin-A.

Materials and methods

A case series with seven adults with stroke (29–74 years) for spastic hypertonia management with passive use objectives (hygiene or positioning) established through Goal Attainment Scaling (GAS). Scores on ULPA Task Performance Mastery (TPM) were obtained through clinical and home-based performances before and after treatment.

Results

Time administration per task ranged from 5-10 min. Median (range) ULPA, Task Performance Mastery (ULPA-TPM) scores pre-intervention of 58 mastery (35–71) improved to 75 (58–88). Tau-U demonstrated significant large effect sizes (≥.65) for five participants. Complementary measures demonstrated improvement of passive performance for five participants and improvements in GAS for six participants. Testing indicates excellent intra-rater (ICC = 0.90) and moderate inter-rater (ICC = 0.64) reliability, with SDC of 10.16 and 18.23%, respectively.

Conclusions

French use of ULPA is a promising standardized, objective and ecologically based assessment of passive performance in adults with stroke. Preliminary findings after TCCA support feasibility for measurement of individualized goals for UL passive use. Future studies may explore other tasks and environments.

Implications for rehabilitation

• ULPA is a performance-based, criterion-referenced and ecological measure of individualized goals based on task-analysis of upper-limb (UL) performance in real-life situations providing an interest for individualized assessment of activity and participation.

• The measure provides a standardized and quantitative approach, applicable to passive use of UL across environments, promoting ecological validity of assessment.

• Preliminary data will support clinical interpretation of change before and after botulinum injections of UL passive performance.

• Access to a transculturally validated French version of ULPA complements standardized assessment of UL impairment, perceived performance and goal attainment.

Keywords:

• Task-based
• reproducibility
• ecological
• Upper-Limb Performance Assessment
• passive function
• performance

Acknowledgements

The authors would like to thank staff of the Occupational Therapy Department of the Physical Medicine and Rehabilitation and Department of Physiological Explorations, University Hospital of Toulouse (Centre Hospitalier Universitaire), France for their assistance during data collection and the National French Association of Occupational Therapists (Association Nationale Française des Ergothérapeutes).

Disclosure statement

C. Villepinte, C. Cormier, M. Couderc, C. Lebely, H-J. Chih, X. de Boissezon, and D. Gasq report no potential conflict of interest to declare. J. Ranka is the Director of the Occupational Performance Network, Sydney Australia, and co-author of Upper-Limb Performance Assessment. She declares no conflict of interest.