Evaluation of functional outcome measures for the hemiparetic upper limb: a systematic review.

OBJECTIVE To identify valid and reliable outcome measures reflective of "real-life" active and passive function for application following focal rehabilitation interventions in the hemiparetic upper limb after stroke or brain injury. METHODS A systematic review of the literature, incorporating a wide-based search including electronic databases, primary reports, abstracts and conference proceedings, was undertaken to identify measures, followed by a literature-based evaluation of the psychometric properties. RESULTS Six measures met the review selection criteria, although 4 were different versions of the Motor Activity Log. None of the measures met all the psychometric evaluation criteria. The tools effectively formed a hierarchy with the ABILHAND and Motor Activity Log representing quite thoroughly evaluated tools of higher level "active function". The Leeds Adult Spasticity Impact Scale addressed lower level tasks and passive function, but had little published psychometric evaluation. CONCLUSION As yet there is no single valid and reliable outcome measure available to capture the full range of "real-life" function in the hemiparetic upper limb. Validated tools are particularly required for passive and lower level function. The selection of measures for clinical evaluation will depend on the patient's level of function and goals for treatment.