Finding a clinical assessment scale - Physical Medicine and Rehabilitation

Description:

Initially developed by Wolf in 1987 [1], it was later modified by Taub [9]. The WMFT quantifies the ability to move the upper limb by simple or multi-joint movements and timed functional tasks in patients in post-stroke chronic phase [7, 11] or sub-acute [12] phase.

It is frequently used to assess motor recovery of the upper member of a brain-injured patient.

Tasks are listed in order of complexity, progressing from the participation of proximal joints to the more distal, and testing overall movements and speed of movement.

This assessment requires few tools and minimal training to run the test [11] and thus avoid ambiguity in how each performance can be scored [8].

All tasks are performed on the same side as quickly as possible and are limited to 120 seconds.

There are 15 tasks and 2 trials of strength.

There are 2 different scores: the WMFT -Time (time required to complete the tasks) and WMFT -FAS (functional Ability Scale, where a score of 6 points is used to assess the functional capacity of each task: 0 indicating that the patient cannot attempt the task, and 5 where the movement seems normal) [5].

It takes a period of 30 to 45 minutes to complete the entire test [2].

There is no difference between the use of video and direct observation by evaluators [10].

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Psychometric properties:

General comment on reliability:

The WMFT is a highly reliable tool [2, 7] (ICC between 0.96 and 0.98) [4]. Internal consistency [2, 7, 8, 11] and inter and intra-judge reproducibility [2, 6, 8, 11] is high. However, according to Nijland [8], the inter-judge reproducibility is worse than intra judge reproducibility, hence the need to train observers for better standardisation of the test.
Post acute stroke, WMFT has an acceptable internal coherence, validity and sensitivity to change. However, compared to the ARAT, the burden of training and testing is not compensated by the much higher psychometric advantages [3].
If we look at the different components of the test: moderate predictive validity for the WMFT Time (compared to the FIM score) and good built validity. For the WMFT FAS, average built validity and low predictive validity. Sensitivity to change is better for the WMFT-FAS than TIME [5]. For WMFT -Time, MDC is 0.7 seconds. For the WMFT -FAS, the MDC is 0.1 percentage point [4].
Concurrent validity is raised using as criterion against the FMA [2, 6, 11] or ARAT [8]. Satisfactory predictive validity [6].
Sensitivity to change is moderate [6]
The MDC (Minimal Change Detection, which is a statistical estimate of the smallest amount of change that can be detected by a measure which corresponds to a significant change) is satisfactory for the ARAT and FMA, hence the usefulness of the 2 tests in a clinical setting with respect to the WMFT [6].

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