Accuracy and Reliability of Remote Categorization of Upper Limb Outcome After Stroke

Abstract

Background: There is an increasing need for motor assessments after stroke that can be performed quickly and remotely. The Fast Outcome Categorization of the Upper Limb after Stroke-4 (FOCUS-4) assessment remotely classifies upper limb outcome into 1 of 4 categories after stroke and was developed via retrospective analysis of Action Research Arm Test (ARAT) scores.

Objective: The aim of this study was to prospectively evaluate the accuracy and reliability of FOCUS-4 assessments for categorizing upper limb outcome after stroke when administered remotely during a videocall compared to an in-person ARAT.

Methods: Data were collected from 26 participants at 3 months post-stroke (3M), 27 participants at 6 months post-stroke (6M), and 56 participants at the chronic stage of stroke (>6M). Participants performed an in-person ARAT and a remote FOCUS-4 assessment administered during a videocall, and accuracy was evaluated by comparing the upper limb outcome categories. Participants at the chronic stage of stroke also performed a second remote FOCUS-4 assessment to assess between-day reliability.

Results: Overall accuracy of the remote FOCUS-4 assessment was 88% at 3M and 96% at 6M. Overall accuracy of the first and second remote FOCUS-4 assessments at the chronic stage was 75% and 79%, respectively. Reliability of the FOCUS-4 assessment at the chronic stage was 82%. The remote FOCUS-4 assessment was most accurate and reliable for participants with mild or severe upper limb functional impairment.

Conclusions: The remote FOCUS-4 assessment has potential to classify upper limb functional capacity or to screen possible participants for stroke trials, but external validation is required.

Keywords: home-based assessment; outcome measures; paresis; remote assessment; stroke; upper limb.

Figure 1.

The FOCUS-4 assessment for categorizing upper limb outcome after stroke. Following each task the patient can progress through the assessment via 1 of 2 possible paths. One path has a symbol and the other path does not. The symbol indicates what score the patient needs to achieve to take that path and if the participant does not achieve that score, they will take the path without the symbol. Green ticks indicate a score of 3 for the specified task, orange ticks indicate a score of 2 or 3, and red crosses indicate a score of 0. Participants proceed through the decision tree until an outcome category is reached. The outcome boxes on the right provide ARAT score ranges.