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Action Research Arm Test
Availability
Please visit this website for more information about the instrument: Action Research Arm Test
The ARAT can be obtained by emailing info@saliarehab.com
Classification
Supplemental: Stroke
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
Observer-rated, performance-based assessment of upper extremity function and dexterity. It evaluates a person's ability to handle objects differing in shape, size and weight.
Comments/Special Instructions
19 items in 4 subsets:  
Grasp (6 items)
Grip (4 items)
Pinch (6 items)
Gross arm movement (3 items)
 
Length of Test: 6 to 30 minutes, dependent on number of items performed.
Scoring and Psychometric Properties
Scoring: 4-point ordinal scale from 0 (no movement) to 3:
3: Performs test normally
2: Completes test, but takes abnormally long or has great difficulty
1: Performs test partially
0: Can perform no part of test
 
Lyle's decision rule: Patients who achieve a maximum score on the first (most difficult) item are credited with having scored 3 on all subsequent items on that scale. If the patient scores less than 3 on the first item, then the second item is assessed. This is the easiest item, and if patients score 0 then they are unlikely to achieve a score above 0 for the remainder of the items and are credited with a zero for the other items. The maximum score on the ARTS is 57 points (possible range 0 to 57).
 
Items can also be summed (van der Lee et al, 2002).
 
A standardized scoring protocol has been published by Yozbatiran 2008.
 
Psychometric Properties: Methodological quality of psychometric properties range from poor to excellent. Best evidence synthesis determined moderate positive evidence for using the ARAT with people without limb spasticity: intra-rater reliability (ICC 0.71 (95% CI 0.53–0.89) to 0.99 (95% CI 0.98, 0.99)); responsiveness (ROC curve 0.72–0.88, SRM 0.89); and regarding construct validity, it is a valid measure of activity limitation. Limited evidence for psychometric properties of the ARAT were found when used with people with upper limb spasticity for construct validity and responsiveness (ES 0.55–0.78). Gaps in evidence were found for inter and test–retest reliability, measurement error, content validity, structural validity, floor and ceiling effects.
References
Alt Murphy M, Resteghini C, Feys P, Lamers I. An overview of systematic reviews on upper extremity outcome measures after stroke. BMC Neurol. 2015 Mar 11;15:29. doi: 10.1186/s12883-015-0292-6.
 
Bushnell C, Bettger J, Cockroft K, Cramer S, Edelen M, Hanley D, Katzan I, Mattke S, Nilsen D, Piquado T, Skidmore E, Wing K, Yenokyan G. Chronic Stroke Outcome Measures for Motor Function Intervention Trials: Expert Panel Recommendations. Circ Cardiovasc Qual Outcomes. 2015 October; 8(6 Suppl 3): S163-S169. doi: 10.1161/CIRCOUTCOMES. 115.002098.
 
Hsueh IP, Hsieh CL. Responsiveness of two upper extremity function instruments for stroke inpatients receiving rehabilitation. Clin Rehabil. 2002;16(6):617–624.
 
Kwakkel G, Lannin NA, Borschmann K, English C, Ali M, Churilov L, Saposnik G, Winstein C, van Wegen EE, Wolf SL, Krakauer JW, Bernhardt J. Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable.Int J Stroke. 2017 Jul;12(5):451-461. doi: 10.1177/1747493017711813.
 
Lyle RC. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res. 1981;4(4):483–492.
 
Pike S, Lannin NA, Wales K, Cusick A. A systematic review of the psychometric properties of the Action Research Arm Test in neurorehabilitation. Aust Occup Ther J. 2018 Oct;65(5):449-471.
 
Yozbaritan N, Der-Yeghiaian L, Cramer SC. A Standardized Approach to Performing the Action Research Arm Test. Neurorehab Neural Re. 2007;22(1):78-90.