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Research & impact
The ArmA is a measure of difficulty in passive and active function for application following focal therapy intervention and in particular for spasticity interventions, both physical and with botulinum toxin injection. The active and passive sub-scales of the tool are treated as separate constructs, but nevertheless have a relationship and are both important in the achievement of clinically relevant change. The ArmA is likely to have utility in practice for evaluation of spasticity intervention (often for passive function) and other focal rehabilitation interventions such as task practice training for active function improvement.
The ArmA questionnaire is a patient and/or carer-reported 20-item measure of difficulty in passive and active hemiparetic arm function. It consists of a seven-item passive function subscale, and 13-item active function subscale. Using a Likert scoring system between 0 (no difficulty) and 4 (unable to do task), the passive function subscale scores range from 0 (high function) to 28 and the active function subscale scores range from 0 (high function) to 52.
Section A asks about ‘caring’ for your affected arm either yourself with your unaffected arm or by a carer/caregiver or a combination of yourself and the carer/caregiver together. The section does not ask about using your affected arm to complete any of the tasks.
Section B asks what you can do using your affected arm or using both arms together.
For each of the activities listed in the ArmA, the person completing the measure needs to indicate:
If you are unable to complete the questionnaire independently, you may:
Rating of the passive and active subscale items is done on the following scale:
ArmA was developed to produce a patient reported outcome measure of active and passive function in the hemiparetic upper limb. Potential items for inclusion were identified through:
(a) systematic review and analysis of existing measures, and
(b) analysis of the primary goals for treatment in a spasticity service.
Item reduction was achieved through consultation with a small, purposively selected multi-disciplinary group of experienced rehabilitation professionals (n= 10) in a three-round Delphi process. This was followed by a confirmatory survey with a larger group of clinicians (n= 36) and patients and carers (n= 13 pairs). From an initial shortlist of 75 items, 23 items were initially identified for inclusion in the arm activity measure (ArmA), and subsequently refined to a 20-item instrument comprising 7 passive and 13 active function. In common with the six measures identified in the systematic review, a five-point ordinal scaling structure was chosen, with ratings based on activity over the preceding seven days.
The ArmA is designed to measure passive and active function following focal interventions for the hemiparetic upper limb. Content and face validity have initially been addressed within the development process.
Royal College of Physicians, British Society of Rehabilitation Medicine, The Chartered Society of Physiotherapy, Association of Chartered Physiotherapists in Neurology and the Royal College of Occupational Therapists. Spasticity in adults: management using botulinum toxin. National guidelines. London: RCP, 2018.
The ArmA is used internationally for assisting in goal setting and outcome evaluation for spasticity management and other focal arm and hand rehabilitation interventions.
Euawongyarti P. Buntragulpoontawee M. Ashford S. Rapipong J. Wongpakaran T. (2018) Preliminary evaluation of the reliability, validity and feasibility of the Arm Activity Measure – Thai Version (ArmA-TH) in Cerebrovascular Patients with Upper Limb Spasticity. Health and Quality of Life Outcomes. 16:141, doi.org/10.1186/s12955-018-0971-2.
Ramström T, Bunketorp-Käll L, Wangdell J. Arm activity measure (ArmA): psychometric evaluation of the Swedish version. J Patient Rep Outcomes. 2021 May 12;5(1):39. doi: 10.1186/s41687-021-00310-4. PMID: 33982227; PMCID: PMC8116475.
French, German and Welsh translations are also being developed.
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