***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: Objective To explore potential predictors of self-reported paretic arm use at baseline and after task-specific training ( TST ) in survivors of stroke . Design Data were obtained from a r and omized controlled trial of somatosensory stimulation and upper limb TST in chronic stroke . Setting University laboratory . Participants Chronic ( ≥3mo ) survivors of stroke ( N=33 ; mean age , 62y ; mean stroke duration , 38mo ) . Interventions Participants received 12 sessions of TST preceded by either active ( n=16 ) or sham ( n=17 ) somatosensory stimulation to all 3 peripheral nerves . Main Outcome Measures Demographic and clinical characteristics were entered stepwise into multiple linear regression analyses to determine the factors that best predict baseline Motor Activity Log ( MAL ) amount of use rating and change 3 months after TST . Results The Action Research Arm Test ( ARAT ) score predicted the amount of use at baseline ( R2=.47 , P<.001 ) ; in using this model , an ARAT score of 54 ( maximum of 57 ) is required to score 2.5 on the MAL ( use described as between rarely and sometimes ) . After TST the change in the ARAT score predicted the change in the amount of use ( R2=.31 , P=.001 ) . The predictive power of the model for change at 3 months increased if the Fugl-Meyer Assessment wrist component score was added ( R2=.41 , P=.001 ) . Conclusions Utilization of the paretic upper limb in activities of daily living requires high functional ability . The increase in self-reported arm use after TST is dependent on the change in functional ability . These results provide further guidance for rehabilitation decisions OBJECTIVE To estimate minimal clinical ly important difference ( MCID ) values of several upper-extremity measures early after stroke . DESIGN Data in this report were collected during the Very Early Constraint-induced Therapy for Recovery of Stroke trial , an acute , single-blind r and omized controlled trial of constraint-induced movement therapy . Subjects were tested at the prer and omization baseline assessment ( average days poststroke , 9.5d ) and the first posttreatment assessment ( average days poststroke , 25.9d ) . At each time point , the affected upper extremity was evaluated with a battery of 6 tests . At the second assessment , subjects were also asked to provide a global rating of perceived changes in their affected upper extremity . Anchor-based MCID values were calculated separately for the affected dominant upper extremities and the affected nondominant upper extremities for each of the 6 tests . SETTING Inpatient rehabilitation hospital . PARTICIPANTS Fifty-two people with hemiparesis poststroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Estimated MCID values for grip strength , composite upper-extremity strength , Action Research Arm Test ( ARAT ) , Wolf Motor Function Test ( WMFT ) , Motor Activity Log ( MAL ) , and duration of upper-extremity use as measured with accelerometry . RESULTS MCID values for grip strength were 5.0 and 6.2 kg for the affected dominant and nondominant sides , respectively . MCID values for the ARAT were 12 and 17 points , for the WMFT function score were 1.0 and 1.2 points , and for the MAL quality of movement score were 1.0 and 1.1 points for the 2 sides , respectively . MCID values were indeterminate for the dominant ( composite strength ) , the nondominant ( WMFT time score ) , and both affected sides ( duration of use ) for the other measures . CONCLUSIONS Our data provide some of the first estimates of MCID values for upper-extremity st and ardized measures early after stroke . Future studies with larger sample sizes are needed to refine these estimates and to determine whether MCID values are modified by time poststroke This study explored relationships between upper-limb ( UL ) functional limitations and self-reported disability in stroke patients with relatively pure motor hemiparesis who were enrolled in an acute rehabilitation treatment trial . All participants were enrolled in the VECTORS ( Very Early Constraint Treatment for Recovery from Stroke ) study . VECTORS is a single-center pilot clinical trial of early application of constraint-induced movement therapy ( CIMT ) . All 39 subjects who completed 90 days of VECTORS  were included in this analysis . Trained study personnel who were blinded to the treatment type performed all evaluations . Data in this article examine relationships between assessment s performed 90 days after stroke . Functional limitation measures included the Action Research Arm ( ARA ) test and Wolf Motor Function Test ( WMFT ) , and self-reported disability measures included the Functional Independence Measure ( FIM ) and Motor Activity Log ( MAL ) ( by telephone ) . Mean plus or minus st and ard deviation time from stroke onset to r and omization was 9.4 plus or minus 4.3 days , and median time to follow-up was 99 days ( range 68 - 178 ) . Subjects with perfect or near-perfect scores on the ARA test or WMFT reported residual disability on the FIM and MAL . Quality of movement on the WMFT ( functional ability score ) was not strongly associated with self-reported frequency , and speed of movement on the WMFT ( timed score ) was not associated with self-reported frequency ( MAL amount of use ) . In this early UL intervention trial , we found that perceived disability measures captured information that was not assessed by functional limitation and impairment scales . Our results indicate that excellent motor recovery as measured by functional limitation and impairment scales did not equal restoration of everyday productive UL use and speed of task completion did not translate to actual use . Our results confirm the need for a measurement strategy that is sensitive to change , assesses a broad performance range , and detects meaningful clinical improvements in early rehabilitation intervention trials BACKGROUND AND PURPOSE Of all stroke survivors , 30 % to 66 % are unable to use their affected arm in performing activities of daily living . Although forced use therapy appears to improve arm function in chronic stroke patients , there is no conclusive evidence . This study evaluates the effectiveness of forced use therapy . METHODS In an observer-blinded r and omized clinical trial , 66 chronic stroke patients were allocated to either forced use therapy ( immobilization of the unaffected arm combined with intensive training ) or a reference therapy of equally intensive bimanual training , based on Neuro-Developmental Treatment , for a period of 2 weeks . Outcomes were evaluated on the basis of the Rehabilitation Activities Profile ( activities ) , the Action Research Arm ( ARA ) test ( dexterity ) , the upper extremity section of the Fugl-Meyer Assessment scale , the Motor Activity Log ( MAL ) , and a Problem Score . The minimal clinical ly important difference ( MCID ) was determined at the onset of the study . RESULTS One week after the last treatment session , a significant difference in effectiveness in favor of the forced use group compared with the bimanual group ( corrected for baseline differences ) was found for the ARA score ( 3.0 points ; 95 % CI , 1.3 to 4.8 ; MCID , 5.7 points ) and the MAL amount of use score ( 0.52 points ; 95 % CI , 0.11 to 0.93 ; MCID , 0.50 ) . The other parameters revealed no significant differential effects . One-year follow-up effects were observed only for the ARA . The differences in treatment effect for the ARA and the MAL amount of use scores were clinical ly relevant for patients with sensory disorders and hemineglect , respectively . CONCLUSIONS The present study showed a small but lasting effect of forced use therapy on the dexterity of the affected arm ( ARA ) and a temporary clinical ly relevant effect on the amount of use of the affected arm during activities of daily living ( MAL amount of use ) . The effect of forced use therapy was clinical ly relevant in the subgroups of patients with sensory disorders and hemineglect , respectively Stroke is a leading cause of adult disability and the recovery of motor function is important for independence in activities of daily living . Predicting motor recovery after stroke in individual patients is difficult . Accurate prognosis would enable realistic rehabilitation goal - setting and more efficient allocation of re sources . The aim of this study was to test and refine an algorithm for predicting the potential for recovery of upper limb function after stroke . Forty participants were prospect ively enrolled within 3 days of ischaemic stroke . First ,  shoulder abduction and finger extension strength  were grade d 72 h after stroke onset to compute a shoulder abduction and finger extension score . Secondly , transcranial magnetic stimulation was used to assess the functional integrity of descending motor pathways to the affected upper limb . Third , diffusion-weighted magnetic resonance imaging was used to assess the structural integrity of the posterior limbs of the internal capsules . Finally , these measures were combined in the PREP algorithm for predicting an individual 's potential for upper limb recovery at 12 weeks , measured with the Action Research Arm Test . A cluster analysis was used to independently group patients according to Action Research Arm Test score at 12 weeks , for comparison with predictions from the PREP algorithm . There was excellent correspondence between the cluster analysis of Action Research Arm Test score at 12 weeks and predictions made with the PREP algorithm . The algorithm had positive predictive power of 88 % , negative predictive power of 83 % , specificity of 88 % and sensitivity of 73 % . This study provides preliminary data in support of the PREP algorithm for the prognosis of upper limb recovery in individual patients .  PREP may enable tailored planning of rehabilitation and more accurate stratification of patients in clinical trials In this study , we compared the responsiveness and validity of the Box and Block Test ( BBT ) , the Nine-Hole Peg Test ( NHPT ) , and the Action Research Arm Test ( ARAT ) .  We r and omized 59 patients with stroke into one of three rehabilitation treatments for 3 weeks . We administered six outcome measures  ( BBT , NHPT , ARAT , Fugl-Meyer Assessment [ FMA ] , Motor Activity Log [ MAL ] , and Stroke Impact Scale [ SIS ] h and function domain ) pretreatment and posttreatment . We used the st and ardized response mean ( SRM ) to examine responsiveness and the Spearman rank correlation coefficient ( rho ) to examine concurrent validity . The BBT , NHPT , and ARAT were moderately responsive to change and not significantly different ( SRM = 0.64 - 0.79 ) . The correlations within the BBT , NHPT , and ARAT were moderate to good at pretreatment ( rho = -0.55 to -0.80 ) and posttreatment ( rho = -0.57 to -0.71 ) . The BBT and ARAT showed fair to moderate correlations with the FMA , MAL , and SIS h and function domain at pretreatment and posttreatment ( rho = 0.31 - 0.59 ) , whereas the NHPT demonstrated low to fair correlations with the FMA and MAL ( rho = -0.16 to -0.33 ) and moderate correlations with the SIS h and function domain ( rho = -0.58 to -0.66 ) . Our results indicate that the BBT , NHPT , and ARAT are suitable to detect changes over time . While simultaneously considering the responsiveness and validity attributes , the BBT and ARAT can be considered more appropriate for evaluating dexterous function than the NHPT . Further studies with larger sample s are needed to vali date these findings 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 To test the clinical counterpart of the learned nonuse theory , 25 chronic hemiplegic stroke and head-injured patients with minimal to moderate upper extremity extensor muscle function were required to keep their uninvolved upper extremities within a h and -enclosed sling during waking hours over a 2-week interval . During this forced use period and for 1 year thereafter , changes in force or time-based measures among 21 functional tasks were compared to values at the sixth baseline session , a preintervention time when relearning had plateaued . Significant ( P less than 0.05 , Friedman 's repeated measures followed by Tukey multiple comparison tests ) changes were seen in 19 of the 21 tasks with most persisting at the 1-year follow-up . There were no apparent differences between right- and left-sided involvement or between stroke versus head injury clients ( Mann-Whitney 
    Output:
    
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 .
Gaps in evidence were found for inter and test-retest reliability , measurement error , content validity , structural validity , floor and ceiling effects .
CONCLUSIONS The ARAT is an appropriate measure of activity limitation post-stroke and should be considered for use with people with TBI ; evidence for people with upper limb spasticity is limited .