Test-retest reliability of physiotherapists using the action research arm test in chronic stroke.
Polykarpos Angelos Nomikos, Nicola Spence, Mansour Abdullah Alshehri
PMID 30349163WHAT IT FOUND
Physiotherapists scoring a videotaped chronic stroke patient twice with ARAT produced closely related scores and little average change.
This supports stable scoring, not proof of patient improvement or wider generalisability.
Key findings
01When the same physiotherapists scored a videotaped chronic stroke patient twice with ARAT, their first and second scores were strongly related.
02Mean ARAT scores were 17.4 on test and 16.8 on retest, and the Wilcoxon test did not reach the stricter 0.01 threshold.
03The Bland and Altman analysis showed limits of agreement of ±2.31 points and two outliers.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study used a small convenience and snowball sample of physiotherapists, so it may not represent all therapists. All therapists scored the same videotaped patient, not repeated assessments of real patients, so it cannot show reliability in routine clinical testing. Therapists were not blinded to the video and may have remembered scores, although the second measurement was at least one week later. One participant dropped out, and intention-to-treat analysis included incomplete data. Two outliers were included in the agreement analysis, and the authors said excluding them would have made reliability estimates more precise. The sample was mostly students and staff, and some therapists were fasting during Ramadan, factors that may have affected scoring.
Declared interests
The author declares no competing interests.
The easy way to misread this
Do not conclude that ARAT is reliable for every patient or that any change in a patient's score is clinically meaningful. This study only showed consistency when physiotherapists scored the same videotaped chronic stroke patient twice, and it included a small sample with two outliers.