# ESTABLISHING LEVELS OF ARM–HAND ACTIVITIES IN STROKE PATIENTS: THE ARM-HAND-ACTIVITIES-SCALE (AHAS)

## TL;DR

The AHAS is a new scale to classify arm–hand activity limitations after stroke, offering a quick and simple way to assess severity and guide treatment.

## Contribution

The AHAS provides a novel, validated classification system for arm–hand activities post-stroke, similar to the FAC for ambulation.

## Key findings

- The AHAS showed good to excellent inter-rater reliability and strong correlations with existing assessments like the ARAT.
- The scale was found to be sensitive to changes in arm–hand activities during rehabilitation.
- Professionals demonstrated consistent understanding of the AHAS categories.

## Abstract

Post-stroke limitations in arm–hand activities are prevalent, yet a system for categorizing these limitations like the Functional Ambulation Categories (FAC) is lacking. The Arm-Hand-Activities-Scale (AHAS) was developed and psychometric properties of this classification were investigated.

Mixed methods to examine comprehensibility, inter-rater reliability, correlations with the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT), and sensitivity to change.

76 professionals answered a comprehensibility questionnaire and 85 professionals an inter-rater reliability questionnaire.

For comprehensibility and inter-rater reliability, standardized video sequences of each category were assessed. Cut-off values were identified by comparing the AHAS categories with the FMA (n = 10) and the ARAT (n = 71). For sensitivity-to-change studies, 71 stroke patients were followed for 4 weeks of inpatient rehabilitation. Spearman correlation coefficients were calculated to examine the relationship between AHAS, FMA, and ARAT outcomes. A Wilcoxon signed-rank test was applied for sensitivity to change.

The results on comprehensibility of the AHAS categories and the FMA cutoff values were highly consistent. Inter-rater reliability was good to excellent. A significant and strong correlation was found between ARAT and AHAS. The Wilcoxon signed-rank test for sensitivity to change was also significant.

The AHAS provides a quick and simple classification system to assess the severity of arm–hand activity limitations after stroke This may help in selecting appropriate treatment strategies.

Arm–hand use is limited in more than 65% of patients after stroke. Measuring activity is important for goal setting and treatment planning but can be time consuming and difficult to understand. The Arm-Hand Activities Scale was developed as an observational scale on 5 levels to classify arm–hand activities in a simple and comprehensible way. Here we investigated whether 2 or more people have the same understanding of the levels, whether they reach a similar rating, and whether this categorization is sensitive to changes in arm and hand activities. All tests achieved good to very good results. The Arm-Hand-Activities-Scale is therefore helpful in selecting appropriate treatments.