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Subject of the scale: Impairment: prehension

Action Research Arm test (ARAT)


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The ARAT is an observational test used to assess upper extremity function including its recovery after brain injury.

It was first described in 1981 by Lyle [1] as a modification of a previous test, the Upper Extremity Function Test (Carroll, 1965).

The test takes about ten minutes, requiring no special training. However, it requires a fairly complete set of equipment (wooden cubes of different sizes, balls, carafe and glass beads, tubes...).

There are 19 items divided into four subgroups: grasp, grip, pinch, and overall movements of the arm. The performance of each item is scored on a 4-point scale: 0 (no movement possible) to 3 (normal movement)

If the patient gets the maximum score on the first item (which is the most difficult) of a sub- group, he is automatically credited with the maximum score for all items of the subgroup (without need for stains).

If the score is less than 3, the second item is tested. The latter is the easiest sub -group, and if the patient has a score of 0, he will be automatically credited him the same score for the following items of the subgroup.

At least one item per subgroup is tested. [10].

The minimum score is 0, the maximum 57.

A test with 15 items has been proposed [5].

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Psychometric properties:


Psychometric properties



Face validity


Content validity


Criterion validity

Concurrent validity

[2] [11] [13] [14] [15] [17]

Predictive validity

[12] [13] [18]

Construct validity

Convergent validity

[6] [7] [8] [12] [20]

Divergent validity

[6] [8] [12]

Discriminant validity
(sensitivity and distinctiveness)

[6] [8] [12] [20]


Intra-rater reliability

[4] [11] [15]

Inter-rater reliability

[2] [4] [6] [11] [12] [13] [15]


[3] [6] [12] [13]

Internal consistency (alpha)

[5] [15] [18]


[3] [5] [7] [8] [12] [13] [14] [16] [17]

General comment on reliability:

A review of the literature was performed [19] to examine the psychometric properties and clinical utility of various assessment tools of the upper limbs in people with motor disabilities of neurological origin in order to provide recommendations for practice. From a total of 31 tools identified, only two measures meet the psychometric properties and clinical utility criteria : the BBT and ARAT.
Sensitivity varies according to studies : quite low [16 ] thus the FMA and MSS (Motor Status Scale) would be better choices to assess functional improvement post AVC through rehabilitation using robotics on upper extremities, the two CAHAI scales (Chedoke Arm and Hand Activity Inventory) also have a higher sensitivity to change than the ARAT [7], moderate [13] or good [12], [8] in the first weeks and months after stroke, and are more sensitive to change than the FMA in post - stroke patients in chronic phase [3], or even higher [17].
This is a one-dimensional tool with a very good internal consistency [5, 15, 18]. However, 2 tasks: "place your hand behind the head " and "put your hand on the head" are not adequate because of bias (varies according to age) [18].
Very good inter-judge reproducibility [2, 4, 6, 11, 13] and intra- judge [4, 11, 15], high test -retest reliability [6].
Highly significant and good concurrent validity correlations, compared to WMFT [15], the FMA [6, 13] and BBT [6, 17]. Good constructed validity [12]. There is currently no discriminant validity between the ARAT and emotions, memory, communication, the GHQ- 30 (General Health Questionnaire) score and the socio -economic level [20]. Variable predictive validity: low [12], satisfactory [13], good [18].
The BBT and the ARAT seem more appropriate for evaluating dexterity than the Nine Hole Peg Test [14].
Compared to the ARAT, the burden of training and testing of WMFT is not offset by much higher psychometric benefits [21].
The minimal clinically important difference (MCID), that is to say the smallest change a patient or doctor considers important in a measure of clinical outcomes was evaluated according to studies at 12 points for the dominant hand [9] or 5.7 points [4].
Satisfactory MDC for the FMA and ARAT: usefulness of its two tests in the clinical setting [13].

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For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. Thibaud Honoré :


Inaugural references:

[1] Lyle RC. "A performance test for assessment of upper limb function in physical rehabilitation treatment and research." Int J Rehabil Res. 1981;4(4):483-92.

Psychometric references:

[2] Hsieh CL, Hsueh IP, Chiang FM, Lin PH. "Inter-rater reliability and validity of the action research arm test in stroke patients." Age Ageing. 1998 Mar;27(2):107-13.

[3] Van der Lee JH, Beckerman H, Lankhorst GJ, Bouter LM. "The responsiveness of the Action Research Arm test and the Fugl-Meyer Assessment scale in chronic stroke patients." J Rehabil Med. 2001 Mar;33(3):110-3.

[4] Van der Lee JH, De Groot V, Beckerman H, Wagenaar RC, Lankhorst GJ, Bouter LM. "The intra- and interrater reliability of the action research arm test: a practical test of upper extremity function in patients with stroke." Arch Phys Med Rehabil. 2001 Jan;82(1):14-9.

[5] Van der Lee JH, Roorda LD, Beckerman H, Lankhorst GJ, Bouter LM. "Improving the Action Research Arm test: a unidimensional hierarchical scale." Clin Rehabil. 2002 Sep;16(6):646-53.

[6] Platz T, Pinkowski C, van Wijck F, Kim IH, di Bella P, Johnson G. "Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study." Clin Rehabil. 2005 Jun;19(4):404-11.

[7] Barreca SR, Stratford PW, Masters LM, Lambert CL, Griffiths J. "Comparing 2 versions of the Chedoke Arm and Hand Activity Inventory with the Action Research Arm Test." Phys Ther 86(2): 245-253.

[8] Lang CE, Wagner JM, Dromerick AW, Edwards DF. "Measurement of upper-extremity function early after stroke: properties of the action research arm test." Arch Phys Med Rehabil. 2006 Dec;87(12):1605-10.

[9] Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW. "Estimating minimal clinically important differences of upper-extremity measures early after stroke." Arch Phys Med Rehabil. 2008 Sep;89(9):1693-700. doi: 10.1016/j.apmr.2008.02.022.

[10] McDonnell M. "Action research arm test." Aust J Physiother. 2008;54(3):220.

[11] Yozbatiran N, Der-Yeghiaian L, Cramer SC. "A standardized approach to performing the action research arm test." Neurorehabil Neural Repair. 2008 Jan-Feb;22(1):78-90. Epub 2007 Aug 17.

[12] Hsieh YW, Wu CY, Lin KC, Chang YF, Chen CL, Liu JS. "Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation." Stroke. 2009 Apr;40(4):1386-91. doi: 10.1161/STROKEAHA.108.530584. Epub 2009 Feb 19.

[13] Lin JH, Hsu MJ, Sheu CF, Wu TS, Lin RT, Chen CH, Hsieh CL. "Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke." Phys Ther. 2009 Aug;89(8):840-50. doi: 10.2522/ptj.20080285. Epub 2009 Jun 25.

[14] Lin KC, Chuang LL, Wu CY, Hsieh YW, Chang WY. "Responsiveness and validity of three dexterous function measures in stroke rehabilitation." J Rehabil Res Dev. 2010;47(6):563-71.

[15] Nijland, R., E. van Wegen, et al. (2010). "A comparison of two validated tests for upper limb function after stroke: The Wolf Motor Function Test and the Action Research Arm Test." J Rehabil Med 42(7): 694-696.

[16] Wei XJ, Tong KY, Hu XL. "The responsiveness and correlation between Fugl-Meyer Assessment, Motor Status Scale, and the Action Research Arm Test in chronic stroke with upper-extremity rehabilitation robotic training." Int J Rehabil Res. 2011 Dec;34(4):349-56. doi: 10.1097/MRR.0b013e32834d330a.

[17] Chanubol R, Wongphaet P, Ot NC, Chira-Adisai W, Kuptniratsaikul P, Jitpraphai C. "Correlation between the action research arm test and the box and block test of upper extremity function in stroke patients." J Med Assoc Thai. 2012 Apr;95(4):590-7.

[18] Chen HF, Lin KC, Wu CY, Chen CL. "Rasch validation and predictive validity of the action research arm test in patients receiving stroke rehabilitation." Arch Phys Med Rehabil. 2012 Jun;93(6):1039-45. doi: 10.1016/j.apmr.2011.11.033. Epub 2012 Mar 14.

[19] Connell LA, Tyson SF. "Clinical reality of measuring upper-limb ability in neurologic conditions: a systematic review." Arch Phys Med Rehabil. 2012 Feb;93(2):221-8. doi: 10.1016/j.apmr.2011.09.015.

[20] Doussoulin SA, Rivas SR, Campos SV. "[Validation of "Action Research Arm Test" (ARAT) in Chilean patients with a paretic upper limb after a stroke]." Rev Med Chil. 2012 Jan;140(1):59-65. doi: /S0034-98872012000100008. Epub 2012 Apr 12.

[21] Edwards DF, Lang CE, Wagner JM, Birkenmeier R, Dromerick AW. "An evaluation of the Wolf Motor Function Test in motor trials early after stroke." Arch Phys Med Rehabil. 2012 Apr;93(4):660-8. doi: 10.1016/j.apmr.2011.10.005. Epub 2012 Feb 13.

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