***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — The Motor Activity Log ( MAL ) is a semistructured interview for hemiparetic stroke patients to assess the use of their paretic arm and h and ( amount of use [ AOU ] ) and quality of movement [ QOM ] ) during activities of daily living . Scores range from 0 to 5 . The following clinimetric properties of the MAL were quantified : internal consistency ( Cronbach α ) , test – retest agreement ( Bl and and Altman method ) , cross-sectional construct validity ( correlation between AOU and QOM and with the Action Research Arm [ ARA ] test ) , longitudinal construct validity ( correlation of change on the MAL during the intervention with a global change rating [ GCR ] and with change on the ARA ) , and responsiveness ( effect size ) . Methods — Two baseline measurements 2 weeks apart and 1 follow-up measurement immediately after 2 weeks of intensive exercise therapy either with or without immobilization of the unimpaired arm ( forced use ) were performed in 56 chronic stroke patients . Results — Internal consistency was high ( AOU : α=0.88 ; QOM : α=0.91 ) . The limits of agreement were −0.70 to 0.85 and −0.61 to 0.71 for AOU and QOM , respectively . The correlation with the ARA score ( Spearman ρ ) was 0.63 ( AOU and QOM ) . However , the improvement on the MAL during the intervention was only weakly related to the GCR and to the improvement on the ARA , Spearman ρ was between 0.16 and 0.22 . The responsiveness ratio was 1.9 ( AOU ) and 2.0 ( QOM ) . Conclusion — The MAL is internally consistent and relatively stable in chronic stroke patients not undergoing an intervention . The cross-sectional construct validity of the MAL is reasonable , but the results raise doubt about its longitudinal construct validity Background and Purpose — The Wolf Motor Function Test ( WMFT ) is a new time-based method to evaluate upper extremity performance while providing insight into joint-specific and total limb movements . This study addresses selected psychometric attributes of the WMFT applied to a chronic stroke population . Methods — Nineteen individuals after stroke and with intact cognition and sitting balance were age- and sex-matched with 19 individuals without impairment . Subjects performed the WMFT and the upper extremity portion of the Fugl-Meyer Motor Assessment ( FMA ) on 2 occasions ( 12 to 16 days apart ) , with scoring performed independently by 2 r and om raters . Results — The  WMFT and FMA demonstrated agreement ( P < 0.0001 ) between raters at each session .  WMFT  scores for the dominant and nondominant extremities of individuals without impairment were different ( P ≤0.05 ) from the more and less affected extremities of subjects after stroke . The FMA score for the more affected extremity of subjects after stroke was different ( P ≤0.05 ) from the dominant and nondominant extremities . However , the FMA score for the less affected upper extremity of individuals after stroke was not different ( P > 0.05 ) from the dominant and nondominant extremities of individuals without impairment . The WMFT and FMA scores were related ( P < 0.02 ) for the more affected extremity in individuals after stroke . Conclusions — The interrater reliability , construct validity , and criterion validity of the WMFT , as used in these subject sample s , are supported Background and Purpose — Health-related quality of life ( HRQOL ) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery . This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery . Methods — Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial ( Extremity Constraint-Induced Therapy Evaluation ) . HRQOL was assessed using the  Stroke Impact Scale ( SIS ) , Version 3.0 . The Wolf Motor Function Test documented functional recovery of the hemiplegic upper extremity . Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains . Results — Age , gender , education level , stroke type , concordance ( paretic arm = dominant h and ) , upper extremity motor function ( Wolf Motor Function Test ) , and comorbidities were associated across SIS domains . Poorer HRQOL in the physical domain was associated with age , nonwhite race , more comorbidities , and reduced upper-extremity function . Stroke survivors with more comorbidities reported poorer HRQOL in the area of memory and thinking , and those with an ischemic stroke and concordance reported poorer communication . Conclusions — Although results may not generalize to lower functioning stroke survivors , individual characteristics of persons with mild to moderate stroke may be important to consider in developing comprehensive , targeted interventions design ed to maximize recovery and improve HRQOL The  Motor Status Scale ( MSS ) measures shoulder , elbow ( maximum score = 40 ) , wrist , h and , and finger movements ( maximum score = 42 ) , and exp and s the measurement of upper extremity impairment and disability provided by the Fugl-Meyer ( FM ) score . This work examines the interrater reliability and criterion validity of the MSS performed in patients admitted to a rehabilitation hospital 21 ± 4 days after stroke . Using the MSS and the FM , 7 occupational therapists masked to each other ’s judgments , evaluated 12 consecutive patients with stroke . Two therapists evaluated 6 additional patients on consecutive days . Intraclass correlation coefficients were significant for each group of raters for the shoulder/elbow and for the wrist/h and ( P < 0.0001 ) ; test-retest measures were also significant for the shoulder/elbow ( Pearson correlation coefficient r = 0.99 , P < 0.004 ) and for the wrist/h and ( Pearson correlation coefficient r = 0.99 , P < 0.003 ) . The internal item consistency for the overall MSS was significant ( Cronbach alpha = 0.98 , P < 0.0001 ) . Finally the correlation between the MSS and the FM ( R 2 = 0.964 ) was significant ( P < 0.0001 ) . The MSS affords a reliable and valid assessment of upper limb impairment and disability following stroke OBJECTIVES To determine the intra- and interrater reliability of the Action Research Arm ( ARA ) test , to assess its ability to detect a minimal clinical ly important difference ( MCID ) of 5.7 points , and to identify less reliable test items . DESIGN Intrarater reliability of the sum scores and of individual items was assessed by comparing ( 1 ) the ratings of the laboratory measurements of 20 patients with the ratings of the same measurements recorded on videotape by the original rater , and ( 2 ) the repeated ratings of videotaped measurements by the same rater . Interrater reliability was assessed by comparing the ratings of the videotaped measurements of 2 raters . The result ing limits of agreement were compared with the MCID . PATIENTS Stratified sample , based on the intake ARA score , of 20 chronic stroke patients ( median age , 62yr ; median time since stroke onset , 3.6yr ; mean intake ARA score , 29.2 ) . MAIN OUTCOME MEASURES Spearman 's rank-order correlation coefficient ( Spearman 's rho ) ; intraclass correlation coefficient ( ICC ) ; mean difference and limits of agreement , based on ARA sum scores ; and weighted kappa , based on individual items . RESULTS All intra- and interrater Spearman 's rho and ICC values were higher than .98 . The mean difference between ratings was highest for the interrater pair ( .75 ; 95 % confidence interval , .02 - 1.48 ) , suggesting a small systematic difference between raters . Intrarater limits of agreement were -1.66 to 2.26 ; interrater limits of agreement were -2.35 to 3.85 . Median weighted kappas exceeded .92 . CONCLUSION The high intra- and interrater reliability of the ARA test was confirmed , as was its ability to detect a clinical ly relevant difference of 5.7 points OBJECTIVE To examine the responsiveness and validity of the Action Research Arm Test ( ARAT ) in a population of subjects with mild-to-moderate hemiparesis within the first few months after stroke . DESIGN Data were collected as part of the Very Early Constraint-Induced Therapy for Recovery from Stroke trial , an acute , single-blind r and omized controlled trial of constraint-induced movement therapy . Subjects were studied at baseline ( day 0 ) , after treatment ( day 14 ) , and after 90 days ( day 90 ) poststroke . SETTING Inpatient rehabilitation hospital ; follow-up 3 months poststroke . PARTICIPANTS Fifty hemiparetic subjects . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES At each time point , subjects were tested on : ( 1 ) the ARAT , ( 2 ) clinical measures of sensorimotor impairments , ( 3 ) in the kinematics laboratory where they performed reach and grasp movements , and ( 4 ) clinical measures of disability . Blinded raters performed all evaluations . Analyses at each time point included calculating effect size as indicators of responsiveness , and correlation and regression analyses to examine relationships between ARAT scores and other measures . RESULTS The ARAT is responsive to change , with effect sizes greater than 1.0 and responsiveness ratios of 7.0 at 3 months poststroke .  ARAT scores were related to sensorimotor impairment measures , 3-dimensional kinematic measures of movement performance , and disability measures at all 3 time points . CONCLUSIONS The ARAT is a responsive and valid measure of upper-extremity functional limitation and therefore may be an appropriate measure for use in acute upper-extremity rehabilitation trials A mental health enterprise may be described by either ( a ) rather general philosophical total mental health goals , or ( b ) highly diverse and individualized patient-therapist goals . Goals a. have not provided a workable framework for program evaluation . This paper proposes that evaluation be done in the framework of goals b. by setting up , before treatment , a measurable scale for each patient-therapist goal , and specifying , for each patient , a transformation of his overall goal attainment into a st and ardized T-score . This method , together with r and om assignment of patients to treatment modes , was devised to permit comparison of treatment modes within a program , but it also provides a good basis for a judgmental evaluation of the total program The Wolf Motor Function Test ( WMFT ) has been used in rehabilitation studies of chronic stroke patients , but until now its psychometric properties have not been evaluated in patients with subacute stroke . Two hundred twenty-nine participants with subacute stroke ( 3 - 9 months postinjury ) at 7 research sites met inclusion criteria for the EXCITE Trial and were r and omized into immediate or delayed ( by 1 year ) constraint-induced movement therapy treatment . All evaluations were undertaken by assessors st and ardized in the administration of the WMFT and masked to treatment design ation . Participants were also assessed using the  Fugl Meyer Motor Assessment ( FMA ) . Delayed group members had measurements repeated 2 weeks following baseline assessment to determine learning or exposure effects . The results demonstrate that the WMFT differentiated higher from lower functioning participants across sites ; scores were uninfluenced by h and dominance or affected side . Women exhibited slower performance times than men . The Functional Ability scale ( FAS ) portion of the WMFT also revealed lower scores among lower functioning participants and women . Minimal changes were observed after repeating the WMFT among delayed group participants 2 weeks later . The FMA revealed similar results when the total group was divided into higher and lower functional levels at its midpoint score of 33 . The WMFT discriminates higher from lower functioning participants tested across research sites . Comparable findings using the FMA support the criterion validity of the WMFT Manual dexterity is a skill frequently evaluated in rehabilitation to estimate h and function . Several tests have been developed for this purpose , including the Box and Block Test ( BBT ) that measures gross manual dexterity . The goal of the present study was to verify the test-retest reliability and construct validity of the BBT with subjects aged 60 and over with upper limb impairment . The second objective of this research was to develop normative data based on a r and om sample of healthy elderly community-living individuals . The results show that the test-retest reliability is high ( intraclass correlations coefficients of 0.89 to 0.97 ) and the validity of the test is shown by significant correlations between the BBT , an upper limb performance measurement and a functional independence measurement . The norms will help rehabilitation clinicians to differentiate better between real difficulties and those that may be attributed to normal aging Although rehabilitation is thought to be under research ed , some data suggest that evaluative r and omized controlled trials ( RCTs ) form a greater proportion of studies in rehabilitation research than in the general medical literature . Various obstacles to more evaluative research are sometimes put forward . These include suggestions that it is unethical , that the personalized nature of rehabilitation coupled with the unique problems of each patient make it impossible to study groups , that patients will not agree to enter trials , and that the funding mechanisms for both service and research are not available . In practice these arguments probably reflect low self-confidence within the profession . Education of the profession , public and purchasers should help in the long term . Meanwhile rehabilitation research would benefit from the development of stable research units of adequate size conjoined with clinical units OBJECTIVE To assess the relative responsiveness of 2 commonly used upper-extremity motor scales , the Action Research Arm Test ( ARAT ) and the Fugl-Meyer Assessment ( FMA ) , in evaluating recovery of upper-extremity function after an acute stroke in patients undergoing inpatient rehabilitation . DESIGN Prospect i ve . SETTING An acute stroke rehabilitation unit . PARTICIPANTS One hundred four consecutive admissions ( 43 men , 61 women ; mean age + /- st and ard deviation , 72+/-13y ) to a rehabilitation unit 16+/-9 
    Output:
    
The Box and Block and the Action Research Arm Tests produce robust data and are feasible for use in clinical practice .