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Keh-chung Lin - One of the best experts on this subject based on the ideXlab platform.
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changes in structural integrity are correlated with Motor and Functional recovery after post stroke rehabilitation
Restorative Neurology and Neuroscience, 2015Co-Authors: Yang Teng Fan, Keh-chung Lin, Holing Anthony Liu, Yao Liang ChenAbstract:Purpose Diffusion tensor imaging (DTI) studies indicate the structural integrity of the ipsilesional corticospinal tract (CST) and the transcallosal Motor tract, which are closely linked to stroke recovery. However, the individual contribution of these 2 fibers on different levels of outcomes remains unclear. Here, we used DTI tractography to investigate whether structural changes of the ipsilesional CST and the transcallosal Motor tracts associate with Motor and Functional recovery after stroke rehabilitation. Methods Ten participants with post-acute stroke underwent the Fugl-Meyer Assessment (FMA), the Wolf Motor Function Test (WMFT), the Functional Independence Measure (FIM), and DTI before and after bilateral robotic training. Results All participants had marked improvements in Motor performance, Functional use of the affected arm, and independence in daily activities. Increased fractional anisotropy (FA) in the ipsilesional CST and the transcallosal Motor tracts was noted from pre-treatment to the end of treatment. Participants with higher pre-to-post differences in FA values of the transcallosal Motor tracts had greater gains in the WMFT and the FIM scores. A greater improvement on the FMA was coupled with increased FA changes along the ipsilesional CST. Conclusions These findings suggest 2 different structural indicators for post-stroke recovery separately at the impairment-based and Function-based levels.
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Measurement properties of streamlined wolf Motor Function Test in patients at subacute to chronic stages after stroke.
Neurorehabilitation and neural repair, 2014Co-Authors: Hui-fang Chen, Yuh Jang, Keh-chung Lin, Shih-chieh Lin, Ju-wen Cheng, Chia-ying Chung, Yanning YanAbstract:Background. Previous research using the streamlined Wolf Motor Function Test (SWMFT) has focused either on the 3- to 9-month period or on the >12-month period after stroke and lacked the information for those at 9 to 12 months. Whether SWMFT scores reflect Motor deficit and recovery from early to late stages after stroke remains unclear. Objective. A retrospective study using the Functional Ability Scale (FAS) was conducted to evaluate whether all SWMFTs items measure the poststroke recovery of upper extremity (UE) Motor Function and if they could be used for patients within 9 to 12 months after a stroke. Methods. Rasch analysis was conducted, and data were drawn from patients 3 months to years after a stroke. Results. The continuum of UE Motor Function in SWMFT-FAS was supported. Subacute patients had the best Motor Function, followed by the 9- to 12-month group, and then chronic patients. Variation in UE Motor Function was large (2.35-2.72 logits), and Motor abilities of these 3 groups overlapped. The 8 SWMFT items could target a broad range of UE Motor Function, from −8.28 to 7.80 logits. The average difficulty of these 8 items also matched the UE Motor ability of the subgroup at 9 to 12 months after stroke, and individual versions of the SWMFT performed well to assess the Motor ability of this group. Conclusions. The SWMFTs had sound hierarchical properties. The SWMFT-Chronic or the SWMFT-Subacute could be used to evaluate UE Function of this subgroup at 9 to 12 months after stroke.
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Rasch Validation of the Streamlined Wolf Motor Function Test in People With Chronic Stroke and Subacute Stroke
Physical therapy, 2012Co-Authors: Hui-fang Chen, Hsiehching Chen, Keh-chung Lin, Carl Pc Chen, Chih-kuang ChenAbstract:Background The construct validity and reliability of the short form of the Wolf Motor Function Test (S-WMFT) in people with subacute stroke and chronic stroke (S-WMFT subacute stroke and chronic stroke versions) have not been investigated. Objective The purpose of this study was to investigate the dimensionality, item difficulty hierarchy, differential item Functioning (DIF), and reliability of the S-WMFT subacute stroke and chronic stroke versions in people with mild to moderate upper-extremity (UE) dysFunction. Design This was a secondary study in which data collected from randomized controlled trials were used. Methods Data were collected at baseline from 97 people with chronic stroke (>12 months after stroke) and 75 people with subacute stroke (3–9 months after stroke) at 3 medical centers in Taiwan. Test structure, hierarchical properties, DIF, and reliability were assessed with Rasch analysis. Results The Test structure for both versions was unidimensional. No DIF relevant to sex, age, or stroke location (hemispheric laterality) was detected. The tasks of moving a hand to a box and moving a hand to a table in the S-WMFT for subacute stroke showed a significantly high correlation. The reliability coefficients for both versions were approximately .90. Limitations The findings were limited to people with stroke and mild to moderate impairment of UE Function. Conclusions The S-WMFT subacute stroke and chronic stroke versions are useful tools for assessing UE Function in different subgroups of people with stroke and show evidence of construct validity and reliability. A high correlation between the tasks of moving a hand to a box and moving a hand to a table in the S-WMFT for subacute stroke suggests that the removal of 1 of these 2 items is warranted.
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Psychometric comparison of the shortened Fugl-Meyer Assessment and the streamlined Wolf Motor Function Test in stroke rehabilitation
Clinical rehabilitation, 2011Co-Authors: Keh-chung Lin, Ching-ju Hsieh, Jung-sen Liu, Tien-ni Wang, Pei OuyangAbstract:Objective:We aimed to compare the responsiveness, concurrent and predictive validity of the shortened Fugl-Meyer Assessment (S-FMA) and the streamlined Wolf Motor Function Test (S-WMFT) in persons with subacute stroke.Design:Test–reTest design.Setting:Departments of physical medicine and rehabilitation at three hospitals.Participants:Participants with first-time stroke (N = 51; 38 men, 13 women; mean age ± SD, 55.1 ± 11.7 years) based on scores of Mini-Mental State Examination and Brunnstrom stage.Interventions:Participants received one of three rehabilitation therapies for three weeks and were evaluated at baseline and end of treatment.Main outcome measures:Responsiveness was examined using the paired t-Test and the standardized response mean (SRM). Criterion validity was investigated using the Pearson’s correlation coefficient (r).Results:Changes from baseline to end of treatment assessed by both Tests were significant (P < 0.001). The value for responsiveness of the S-FMA was significantly higher than ...
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Assessing the streamlined Wolf Motor Function Test as an outcome measure for stroke rehabilitation.
Neurorehabilitation and neural repair, 2010Co-Authors: Keh-chung Lin, Chi-tzu Feng, Kuang-ping Hsieh, Chia-huang Lin, Ching-ju Hsieh, Hisaaki OtaAbstract:Objective. This study investigates the clinimetric properties of the streamlined Wolf Motor Function Test (WMFT), a 6-item version of the performance time scale of the WMFT. Methods. The streamline...
Steven L. Wolf - One of the best experts on this subject based on the ideXlab platform.
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A Reaching Performance Scale for 2 Wolf Motor Function Test Items.
Archives of physical medicine and rehabilitation, 2020Co-Authors: Clarisa Martinez, Steven L. Wolf, Helen Bacon, Veronica Rowe, David Russak, Erin Fitzgerald, Michelle Woodbury, Carolee J WinsteinAbstract:Abstract Objective To adapt the Reaching Performance Scale for Stroke (RPSS) for the Wolf Motor Function Test (WMFT) “Lift Can” (Can) and “Hand to Box” (Box) items. Design Retrospective analysis of video-recorded WMFT assessment performed by 3 raters on 2 occasions. Setting Not applicable. Participants Participants (N=29) with mild to moderate upper extremity impairment less than 3 months after stroke. Interventions Not applicable. Main Outcome Measures Inter- and intra-rater agreement, concurrent validity of WMFT-RPSS. Results Mean ± SD inter-rater Gwet’s agreement coefficient (AC2) was 0.61±0.05 for Can WMFT-RPSS and 0.56 (0.03) for Box. Mean ± SD intra-rater AC2 for Can was 0.63±0.05 and 0.70±0.04 for Box. WMFT-RPSS Can and Box scores correlated with log mean WMFT time (C, -0.73; B, -0.48), Functional Ability Scale (C, 0.87; B, 0.62), Upper Extremity Fugl-Meyer Motor Score (C, 0.69; B, 0.51), and item movement rate (C, 0.74; B, 0.71) (P Conclusions WMFT-RPSS demonstrated moderate intra-rater and weak-to-moderate inter-rater agreement for individuals with mild-moderate impairment. For construct validity, Can and Box WMFT-RPSS were significantly correlated with 4 standardized measures. Average WMFT-RPSS scores revealed that some participants may have relied on compensatory movements to complete the task, a revelation not discernable from movement rate alone. The WMFT-RPSS is potentially useful as a valid and reliable tool to examine longitudinal changes in movement quality after stroke.
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Interrater reliability of the Wolf Motor Function Test-Functional Ability Scale: why it matters.
Neurorehabilitation and neural repair, 2014Co-Authors: Susan V. Duff, Steven L. Wolf, Alexander W. Dromerick, Monica A. Nelsen, Christianne J. Lane, Veronica T. Rowe, Carolee J WinsteinAbstract:Background. One important objective for clinical trialists in rehabilitation is determining efficacy of interventions to enhance Motor behavior. In part, limitation in the precision of measurement presents a challenge. The few valid, low-cost observational tools available to assess Motor behavior cannot escape the variability inherent in Test administration and scoring. This is especially true when there are multiple evaluators and raters, as in the case of multisite randomized controlled trials (RCTs). One way to enhance reliability and reduce variability is to implement rigorous quality control (QC) procedures. Objective. This article describes a systematic QC process used to refine the administration and scoring procedures for the Wolf Motor Function Test (WMFT)–Functional Ability Scale (FAS). Methods. The QC process, a systematic focus-group collaboration, was developed and used for a phase III RCT, which enlisted multiple evaluators and an experienced WMFT-FAS rater panel. Results. After 3 staged ref...
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The EXCITE Trial: Analysis of “Noncompleted” Wolf Motor Function Test Items
Neurorehabilitation and neural repair, 2011Co-Authors: Steven L. Wolf, Paul A. Thompson, Emily Estes, Timothy Lonergan, Rozina Merchant, Natasha RichardsonAbstract:Objective. This is the first study to examine Wolf Motor Function Test (WMFT) tasks among EXCITE Trial participants that could not be completed at baseline or 2 weeks later. Methods. Data were coll...
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minimal detectable change scores for the wolf Motor Function Test
Neurorehabilitation and Neural Repair, 2009Co-Authors: Stacy L. Fritz, Gitendra Uswatte, Edward Taub, Sarah Blanton, Steven L. WolfAbstract:BACKGROUND: The Wolf Motor Function Test (WMFT) is an impairment-based Test whose psychometrics have been examined by previous reliability and validity studies. Standards for evaluating whether a given change is meaningful, however, have not yet been addressed. OBJECTIVES: To determine the standard error of measurement (SEM) and minimal detectable change (MDC) for the WMFT. METHODS: Data were collected from 6 university laboratories that participated in the EXCITE national clinical trial and included 96 individuals with sub-acute stroke (3-9 months). Measurements were made by blinded evaluators who were trained and standardized to administer the WMFT, which was completed on 2 occasions 2 weeks apart. No intervention was given between Testing sessions. RESULTS: The WMFT Performance Time score has a SEM of 0.2 seconds and a MDC95 of 0.7 seconds. The individual task timed items MDC95 ranged from 1.0 second (turn key in lock) to 3.4 seconds (reach and retrieve) with individual task items demonstrating notably higher variability than the average WMFT Performance Time. The average WMFT Functional Ability Scale SEM and MDC95 is 0.1 points. CONCLUSIONS: When assessing the effect of a therapeutic intervention, if an individual experiences an amount of change equal to or greater than the MDC, then one may be 95% confident that this margin of change is truly larger than measurement error and not a chance result. Thus, the determination of SEM and MDC in outcome assessments allows researchers and clinicians to distinguish which results are actual differences versus which results are simply changes resulting from error or chance.
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Minimal detectable change scores for the Wolf Motor Function Test.
Neurorehabilitation and neural repair, 2009Co-Authors: Stacy L. Fritz, Gitendra Uswatte, Edward Taub, Sarah Blanton, Steven L. WolfAbstract:Background. The Wolf Motor Function Test (WMFT) is an impairment-based Test whose psychometrics have been examined by previous reliability and validity studies. Standards for evaluating whether a given change is meaningful, however, have not yet been addressed. Objectives. To determine the standard error of measurement (SEM) and minimal detectable change (MDC) for the WMFT. Methods. Data were collected from 6 university laboratories that participated in the EXCITE national clinical trial and included 96 individuals with sub-acute stroke (3—9 months). Measurements were made by blinded evaluators who were trained and standardized to administer the WMFT, which was completed on 2 occasions 2 weeks apart. No intervention was given between Testing sessions. Results. The WMFT Performance Time score has a SEM of 0.2 seconds and a MDC95 of 0.7 seconds. The individual task timed items MDC 95 ranged from 1.0 second (turn key in lock) to 3.4 seconds (reach and retrieve) with individual task items demonstrating notabl...
Deborah S. Nichols-larsen - One of the best experts on this subject based on the ideXlab platform.
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Measurement Structure of the Wolf Motor Function Test: Implications for Motor Control Theory:
Neurorehabilitation and neural repair, 2010Co-Authors: Michelle L. Woodbury, David M Morris, Gitendra Uswatte, Edward Taub, Paul Thompson, Sarah Blanton, Carolee J Winstein, Craig A. Velozo, Kathye E. Light, Deborah S. Nichols-larsenAbstract:Background. Tools chosen to measure poststroke upper-extremity rehabilitation outcomes must match contemporary theoretical expectations of Motor deficit and recovery because an assessment’s theoretical underpinning forms the conceptual basis for interpreting its score. Objective. The purpose of this study was to investigate the theoretical framework of the Wolf Motor Function Test (WMFT) by (1) determining whether all items measured a single underlying trait and (2) examining the congruency between the hypothesized and the empirically determined item difficulty orders. Methods. Confirmatory factor analysis (CFA) and Rasch analysis were applied to existing WMFT Functional Ability Rating Scale data from 189 participants in the EXCITE (Extremity Constraint-Induced Therapy Evaluation) trial. Fit of a 1-factor CFA model (all items) was compared with the fit of a 2-factor CFA model (factors defined according to item object-grasp requirements) with fit indices, model comparison Test, and interfactor correlations...
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Can the Wolf Motor Function Test be streamlined
Neurorehabilitation and neural repair, 2009Co-Authors: Kimberly Bogard, David M Morris, Paul Thompson, Steven L. Wolf, Qin Zhang, Deborah S. Nichols-larsenAbstract:Background. To assess upper extremity (UE) capabilities following stroke, the Wolf Motor Function Test (WMFT) measures time to complete 15 UE tasks and 2 strength tasks, but takes 30 to 45 minutes for the clinician to complete. Objective. In an effort to streamline the WMFT, this study evaluated the association between the magnitude of improvement on any timed task of the WMFT and the change score on all other tasks among participants in the Extremity Constraint Induced Therapy Evaluation (EXCITE) trial. Methods. This association was evaluated using regression methods according to chronicity and controlling for key covariates (Functional level, gender, concordance) for log mean WMFT scores. Results. After controlling for covariates, 6 tasks (hand to table [front], hand to box [front], reach and retrieve, lift can, lift pencil, and fold towel) influenced the overall WMFT score for survivors meeting EXCITE criteria and treated within 3 to 9 months poststroke. Six different tasks (extend elbow weight, hand t...
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Factors Influencing Stroke Survivors’ Quality of Life During Subacute Recovery
Stroke, 2005Co-Authors: Deborah S. Nichols-larsen, Patricia C. Clark, Angelique Zeringue, Arlene Greenspan, Sarah BlantonAbstract:Background and Purpose— Health-related quality of life (HRQOL) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery. This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery. Methods— Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial (Extremity Constraint-Induced Therapy Evaluation). HRQOL was assessed using the Stroke Impact Scale (SIS), Version 3.0. The Wolf Motor Function Test documented Functional recovery of the hemiplegic upper extremity. Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains. Results— Age, gender, education level, stroke type, concordance (paretic arm=dominant hand), upper extremity Motor Function (Wolf Motor Function Test), and comorbidities were associated across SIS domains. Poorer H...
David M Morris - One of the best experts on this subject based on the ideXlab platform.
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Measurement Structure of the Wolf Motor Function Test: Implications for Motor Control Theory:
Neurorehabilitation and neural repair, 2010Co-Authors: Michelle L. Woodbury, David M Morris, Gitendra Uswatte, Edward Taub, Paul Thompson, Sarah Blanton, Carolee J Winstein, Craig A. Velozo, Kathye E. Light, Deborah S. Nichols-larsenAbstract:Background. Tools chosen to measure poststroke upper-extremity rehabilitation outcomes must match contemporary theoretical expectations of Motor deficit and recovery because an assessment’s theoretical underpinning forms the conceptual basis for interpreting its score. Objective. The purpose of this study was to investigate the theoretical framework of the Wolf Motor Function Test (WMFT) by (1) determining whether all items measured a single underlying trait and (2) examining the congruency between the hypothesized and the empirically determined item difficulty orders. Methods. Confirmatory factor analysis (CFA) and Rasch analysis were applied to existing WMFT Functional Ability Rating Scale data from 189 participants in the EXCITE (Extremity Constraint-Induced Therapy Evaluation) trial. Fit of a 1-factor CFA model (all items) was compared with the fit of a 2-factor CFA model (factors defined according to item object-grasp requirements) with fit indices, model comparison Test, and interfactor correlations...
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Can the Wolf Motor Function Test be streamlined
Neurorehabilitation and neural repair, 2009Co-Authors: Kimberly Bogard, David M Morris, Paul Thompson, Steven L. Wolf, Qin Zhang, Deborah S. Nichols-larsenAbstract:Background. To assess upper extremity (UE) capabilities following stroke, the Wolf Motor Function Test (WMFT) measures time to complete 15 UE tasks and 2 strength tasks, but takes 30 to 45 minutes for the clinician to complete. Objective. In an effort to streamline the WMFT, this study evaluated the association between the magnitude of improvement on any timed task of the WMFT and the change score on all other tasks among participants in the Extremity Constraint Induced Therapy Evaluation (EXCITE) trial. Methods. This association was evaluated using regression methods according to chronicity and controlling for key covariates (Functional level, gender, concordance) for log mean WMFT scores. Results. After controlling for covariates, 6 tasks (hand to table [front], hand to box [front], reach and retrieve, lift can, lift pencil, and fold towel) influenced the overall WMFT score for survivors meeting EXCITE criteria and treated within 3 to 9 months poststroke. Six different tasks (extend elbow weight, hand t...
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The Excite Trial: relationship of intensity of constraint induced movement therapy to improvement in the wolf Motor Function Test.
Restorative neurology and neuroscience, 2007Co-Authors: Steven L. Wolf, David M Morris, Sarah Blanton, Carolee J Winstein, Qin Zhang, Heather Newton, Douglas Maddy, Kathye E. LightAbstract:Purpose To examine the relationship between change scores on the log mean Wolf Motor Function Test (lmWMFT) and the intensity of supervised Constraint Induced Movement Therapy (CIMT) in participants with subacute and chronic stroke. Methods A retrospective analysis of data from 169 EXCITE participants who received CIMT either immediately after randomization or one year later was undertaken. During waking hours, participants wore a restraining mitt on the less affected extremity. The lmWMFT was administered before and after the two week treatment block. Results Significant relationships were seen between the intensity of training and Functional score in the immediate, lower Functional group for whom more training in adaptive task practice resulted in poorer outcomes (p=0.01) and in the immediate, higher Functioning group for whom more training in repetitive task practice resulted in poorer outcomes (p=0.02). Female participants in the immediate group showed less progress in lmWMFT scores with greater amounts of total training (p=0.01). Functional level, gender, and concordance did not modify any other relationship. Both higher Functioning participants who trained within the normal ratio (N=50) and who were exposed to more than the prescribed adaptive task practice (N=11) experienced a significant improvement in the lmWMFT score (p=0.03 and p=0.02, respectively) compared to those higher Functioning participants who experienced excessive repetitive task practice. Conclusion Applying CIMT to a large sample of participants with stroke resulted in directionally inappropriate but significant relationships between intensity and lmWMFT scores in the immediate but not the delayed group. Our data also suggest that Functional improvements observed in the EXCITE Trial might be attributable to training components other than the designated ratio of training approaches (adaptive and repetitive task practice).
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the excite trial attributes of the wolf Motor Function Test in patients with subacute stroke
Neurorehabilitation and Neural Repair, 2005Co-Authors: Steven L. Wolf, David M Morris, Dorian K Rose, Edward Taub, Carol Giuliani, Paul Thompson, Carolee J Winstein, Sonya PearsonAbstract:The Wolf Motor Function Test (WMFT) has been used in rehabilitation studies of chronic stroke patients, but until now its psychometric properties have not been evaluated in patients with subacute s...
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the reliability of the wolf Motor Function Test for assessing upper extremity Function after stroke
Archives of Physical Medicine and Rehabilitation, 2001Co-Authors: David M Morris, Jean E Crago, Gitendra Uswatte, Edwin W. Cook, Edward TaubAbstract:Morris DM, Uswatte G, Crago JE, Cook EW III, Taub E. The reliability of the Wolf Motor Function Test for assessing upper extremity Function after stroke. Arch Phys Med Rehabil 2001;82:750-5. Objective: To examine the reliability of the Wolf Motor Function Test (WMFT) for assessing upper extremity Motor Function in adults with hemiplegia. Design: Interrater and Test-reTest reliability. Setting: A clinical research laboratory at a university med- ical center. Patients: A sample of convenience of 24 subjects with chronic hemiplegia (onset 1yr), showing moderate Motor impairment. Intervention: The WMFT includes 15 Functional tasks. Per- formances were timed and rated by using a 6-point Functional ability scale. The WMFT was administered to subjects twice with a 2-week interval between administrations. All Test ses- sions were videotaped for scoring at a later time by blinded and trained experienced therapists. Main Outcome Measure: Interrater reliability was exam- ined by using intraclass correlation coefficients and internal consistency by using Cronbach's alpha. Results: Interrater reliability was .97 or greater for perfor- mance time and .88 or greater for Functional ability. Internal consistency for Test 1 was .92 for performance time and .92 for Functional ability; for Test 2, it was .86 for performance time and .92 for Functional ability. Test-reTest reliability was .90 for performance time and .95 for Functional ability. Absolute scores for subjects were stable over the 2 Test administrations. Conclusion: The WMFT is an instrument with high inter- rater reliability, internal consistency, Test-reTest reliability, and
Sarah Blanton - One of the best experts on this subject based on the ideXlab platform.
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Measurement Structure of the Wolf Motor Function Test: Implications for Motor Control Theory:
Neurorehabilitation and neural repair, 2010Co-Authors: Michelle L. Woodbury, David M Morris, Gitendra Uswatte, Edward Taub, Paul Thompson, Sarah Blanton, Carolee J Winstein, Craig A. Velozo, Kathye E. Light, Deborah S. Nichols-larsenAbstract:Background. Tools chosen to measure poststroke upper-extremity rehabilitation outcomes must match contemporary theoretical expectations of Motor deficit and recovery because an assessment’s theoretical underpinning forms the conceptual basis for interpreting its score. Objective. The purpose of this study was to investigate the theoretical framework of the Wolf Motor Function Test (WMFT) by (1) determining whether all items measured a single underlying trait and (2) examining the congruency between the hypothesized and the empirically determined item difficulty orders. Methods. Confirmatory factor analysis (CFA) and Rasch analysis were applied to existing WMFT Functional Ability Rating Scale data from 189 participants in the EXCITE (Extremity Constraint-Induced Therapy Evaluation) trial. Fit of a 1-factor CFA model (all items) was compared with the fit of a 2-factor CFA model (factors defined according to item object-grasp requirements) with fit indices, model comparison Test, and interfactor correlations...
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minimal detectable change scores for the wolf Motor Function Test
Neurorehabilitation and Neural Repair, 2009Co-Authors: Stacy L. Fritz, Gitendra Uswatte, Edward Taub, Sarah Blanton, Steven L. WolfAbstract:BACKGROUND: The Wolf Motor Function Test (WMFT) is an impairment-based Test whose psychometrics have been examined by previous reliability and validity studies. Standards for evaluating whether a given change is meaningful, however, have not yet been addressed. OBJECTIVES: To determine the standard error of measurement (SEM) and minimal detectable change (MDC) for the WMFT. METHODS: Data were collected from 6 university laboratories that participated in the EXCITE national clinical trial and included 96 individuals with sub-acute stroke (3-9 months). Measurements were made by blinded evaluators who were trained and standardized to administer the WMFT, which was completed on 2 occasions 2 weeks apart. No intervention was given between Testing sessions. RESULTS: The WMFT Performance Time score has a SEM of 0.2 seconds and a MDC95 of 0.7 seconds. The individual task timed items MDC95 ranged from 1.0 second (turn key in lock) to 3.4 seconds (reach and retrieve) with individual task items demonstrating notably higher variability than the average WMFT Performance Time. The average WMFT Functional Ability Scale SEM and MDC95 is 0.1 points. CONCLUSIONS: When assessing the effect of a therapeutic intervention, if an individual experiences an amount of change equal to or greater than the MDC, then one may be 95% confident that this margin of change is truly larger than measurement error and not a chance result. Thus, the determination of SEM and MDC in outcome assessments allows researchers and clinicians to distinguish which results are actual differences versus which results are simply changes resulting from error or chance.
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Minimal detectable change scores for the Wolf Motor Function Test.
Neurorehabilitation and neural repair, 2009Co-Authors: Stacy L. Fritz, Gitendra Uswatte, Edward Taub, Sarah Blanton, Steven L. WolfAbstract:Background. The Wolf Motor Function Test (WMFT) is an impairment-based Test whose psychometrics have been examined by previous reliability and validity studies. Standards for evaluating whether a given change is meaningful, however, have not yet been addressed. Objectives. To determine the standard error of measurement (SEM) and minimal detectable change (MDC) for the WMFT. Methods. Data were collected from 6 university laboratories that participated in the EXCITE national clinical trial and included 96 individuals with sub-acute stroke (3—9 months). Measurements were made by blinded evaluators who were trained and standardized to administer the WMFT, which was completed on 2 occasions 2 weeks apart. No intervention was given between Testing sessions. Results. The WMFT Performance Time score has a SEM of 0.2 seconds and a MDC95 of 0.7 seconds. The individual task timed items MDC 95 ranged from 1.0 second (turn key in lock) to 3.4 seconds (reach and retrieve) with individual task items demonstrating notabl...
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The Excite Trial: relationship of intensity of constraint induced movement therapy to improvement in the wolf Motor Function Test.
Restorative neurology and neuroscience, 2007Co-Authors: Steven L. Wolf, David M Morris, Sarah Blanton, Carolee J Winstein, Qin Zhang, Heather Newton, Douglas Maddy, Kathye E. LightAbstract:Purpose To examine the relationship between change scores on the log mean Wolf Motor Function Test (lmWMFT) and the intensity of supervised Constraint Induced Movement Therapy (CIMT) in participants with subacute and chronic stroke. Methods A retrospective analysis of data from 169 EXCITE participants who received CIMT either immediately after randomization or one year later was undertaken. During waking hours, participants wore a restraining mitt on the less affected extremity. The lmWMFT was administered before and after the two week treatment block. Results Significant relationships were seen between the intensity of training and Functional score in the immediate, lower Functional group for whom more training in adaptive task practice resulted in poorer outcomes (p=0.01) and in the immediate, higher Functioning group for whom more training in repetitive task practice resulted in poorer outcomes (p=0.02). Female participants in the immediate group showed less progress in lmWMFT scores with greater amounts of total training (p=0.01). Functional level, gender, and concordance did not modify any other relationship. Both higher Functioning participants who trained within the normal ratio (N=50) and who were exposed to more than the prescribed adaptive task practice (N=11) experienced a significant improvement in the lmWMFT score (p=0.03 and p=0.02, respectively) compared to those higher Functioning participants who experienced excessive repetitive task practice. Conclusion Applying CIMT to a large sample of participants with stroke resulted in directionally inappropriate but significant relationships between intensity and lmWMFT scores in the immediate but not the delayed group. Our data also suggest that Functional improvements observed in the EXCITE Trial might be attributable to training components other than the designated ratio of training approaches (adaptive and repetitive task practice).
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Factors Influencing Stroke Survivors’ Quality of Life During Subacute Recovery
Stroke, 2005Co-Authors: Deborah S. Nichols-larsen, Patricia C. Clark, Angelique Zeringue, Arlene Greenspan, Sarah BlantonAbstract:Background and Purpose— Health-related quality of life (HRQOL) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery. This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery. Methods— Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial (Extremity Constraint-Induced Therapy Evaluation). HRQOL was assessed using the Stroke Impact Scale (SIS), Version 3.0. The Wolf Motor Function Test documented Functional recovery of the hemiplegic upper extremity. Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains. Results— Age, gender, education level, stroke type, concordance (paretic arm=dominant hand), upper extremity Motor Function (Wolf Motor Function Test), and comorbidities were associated across SIS domains. Poorer H...
