Search

Background: The prevalence of physical inactivity after stroke is high and exercise training improves many outcomes. However, access to community training protocols is limited, especially in low-income settings., Objective: To investigate the feasibility and efficacy of a new intervention: Circuit walking, balance, cycling and strength training (CBCS) on activity of daily living (ADL) limitations, motor performance, and social participation restrictions in people after stroke., Methods: Forty-six community-dwelling individuals with chronic stroke who were no longer in conventional rehabilitation were randomized into an immediate CBCS group (IG; initially received CBCS training for 12 weeks in phase 1), and a delayed CBCS group (DG) that first participated in sociocultural activities for 12 weeks. In phase 2, participants crossed over so that the DG underwent CBCS and the IG performed sociocultural activities. The primary outcome was ADL limitations measured with the ACTIVLIM-Stroke scale. Secondary outcomes included motor performance (balance: Berg Balance Scale [BBS], global impairment: Stroke Impairment Assessment Set [SIAS] and mobility: 6-minute and 10-metre walk tests [6MWT and 10mWT] and psychosocial health [depression and participation]). Additional outcomes included feasibility (retention, adherence) and safety., Results: ADL capacity significantly improved pre to post CBCS training (ACTIVLIM-stroke, +3,4 logits, p < 0.001; effect size [ES] 0.87), balance (BBS, +21 points, p < 0.001; ES 0.9), impairments (SIAS, +11 points, p < 0.001; ES 0.9), and mobility (+145 m for 6MWT and +0.37 m/s for 10mWT; p < 0.001; ES 0.7 and 0.5 respectively). Similar improvements in psychosocial health occurred in both groups. Adherence and retention rates were 95% and 100%, respectively., Conclusion: CBCS was feasible, safe and improved functional independence and motor abilities in individuals in the chronic stage of stroke. Participation in CBCS improved depression and social participation similarly to participation in sociocultural activities. The benefits persisted for at least 3 months after intervention completion., Protocol Registration Number: PACTR202001714888482., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: The PM-Scale was developed specifically to assess participation in individuals after stroke based on the concepts contained in the International Classification of Functioning, Disability and Health. However, this measure is only available in English and French., Objective: To translate and cross-culturally adapt the PM-Scale to Brazilian Portuguese, followed by the validation and testing of reliability of the translated version., Methods: The translation process followed standard guidelines. Preliminary test-retest reliability was determined using the intraclass correlation coefficient (ICC 2,1 ). The Rasch model was employed to analyse the validity, unidimensionality, invariance, and internal consistency of the Brazilian version of the PM-Scale., Results: The final translated version of the PM-Scale presented appropriate semantic, idiomatic, cultural, and conceptual equivalence. The preliminary analysis revealed excellent intra-observer and inter-observer reliability (ICC 2, 1  = 0.91; 95%CI: 0.83, 0.95 and ICC 2, 1  = 0.81; 95%CI: 0.64, 0.89, respectively). The analysis of the Rasch model revealed only one erratic item. An excellent overall fit was found for items (mean ± SD = 0.01 ± 1.02) and adequate fit was found for persons (mean ± SD = 1.16 ± 0.88). Internal consistency was considered adequate (person separation index = 1.77, reliability = 0.76). No significant invariance was found with regards to the personal characteristics of the sample (p > 0.05)., Conclusion: The Brazilian version of the PM-Scale is a valid, unidimensional, linear, reliable scale for measuring participation in stroke survivors and can be administered in less than five minutes., Competing Interests: Declaration of competing interest The authors report no conflicts of interest., (Copyright © 2023 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Rules have been developed to simplify the understanding of researchers/clinicians and standardize the linking process between concepts contained in the items on assessment measures and the International Classification of Functioning, Disability, and Health (ICF)., Objective: Link the concepts of the SATISPART Stroke (SATIS-Stroke) and Participation Measurement Scale (PM-Scale) to ICF codes., Methods: Linking was performed by two evaluators with experience in the ICF taxonomy who applied the ten standard linking rules specifically developed and updated for this purpose. The level of agreement between the evaluators was determined using the Kappa coefficient with 95% confidence intervals., Results: The SATIS-Stroke and PM-Scale address the nine domains of the ICF "Activities and Participation" component. Adequate agreement was found between the researchers during the linking process, mainly between the 1º and 3º evaluators. Identified 41 ICF codes were found among the SATIS-Stroke items and 24 ICF codes were found among the items of the PM-Scale., Conclusion: SATIS-Stroke addresses more issues regarding the domains of Learning and Applying Knowledge, Mobility, Self-Care, Domestic Life, and Major Life Areas, whereas the PM-Scale addresses more issues regarding the General Tasks and Demands, Communication, and Community, Social and Civic Life. Both instruments equally address issues related to Interpersonal Interactions and Relationships.

Purpose: To review and quantify the effects of walking training for the improvement of various aspects of physical function of people with chronic stroke., Methods: We conducted a systematic search and meta-analysis of randomized controlled trials (RCTs) of chronic stroke rehabilitation interventions published from 2008 to 2020 in English or French. Of the 6476-screened articles collated from four databases, 15 RCTs were included and analyzed. We performed a meta-regression with the total training time as dependent variable in order to have a better understanding of how did the training dosage affect the effect sizes., Results: Treadmill walking training was more effective on balance and motor functions (standardized mean difference (SMD)=0.70[0.02, 1.37], p  = 0.04) and 0.56[0.15, 0.96], p  = 0.007 respectively). Overground walking training improved significantly walking endurance (SMD = 0.38[0.16, 0.59], p  < 0.001), walking speed (MD = 0.12[0.05, 0.18], p  < 0.001), participation (SMD = 0.35[0.02, 0.68], p  = 0.04) and quality of life (SMD = 0.46[0.12, 0.80], p  = 0.008). Aquatic training improved balance (SMD = 2.41[1.20, 3.62], p  < 0.001). The Meta-regression analysis did not show significant effect of total training time on the effect sizes., Conclusion: Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in people with chronic stroke.Implications for rehabilitationTreadmill walking training is effective for improving balance and motor functions.Overground walking training improved significantly walking endurance, walking speed, participation and quality of life.Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in patient with chronic stroke.

Background: SATIS-Stroke questionnaire has been translated and adapted for use in the Brazilian population, however, it is necessary to test the measurement properties in Brazilian population., Objective: To test the reliability, agreement, concurrent validity, and diagnostic accuracy of the SATIS-Stroke., Methods: Chronic stroke survivors were included. The calculations were made using scores in logits (Rasch Model). Reliability was tested using the intraclass correlation coefficient (ICC 2,1 ), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plots. Concurrent validity was analyzed using Spearman's correlation coefficient. For such, the correlation between SATIS-Stroke and Stroke Specific Quality of Life (SS-QOL) questionnaires was determined. Diagnostic accuracy was estimated based on the area under the receiver operating characteristic (ROC) curve with a 95% confidence interval and considering the sensitivity and specificity of SATIS-Stroke in differentiating different types of activity and participation., Results: Eighty stroke survivors were analyzed. Mean age was 57.98±13.85 years and 45.2% had severe impairment. Excellent reliability was found (intra-observer ICC 2,1  = 0.90; 95% CI: 0.84, 0.93; inter-observer ICC 2,1  = 0.89; 95% CI: 0.83, 0.93). The Bland-Altman plot demonstrated satisfactory agreement. In the analysis of concurrent validity, a strong, positive, significant correlation was found between SATIS-Stroke and SS-QOL (r s = 0.74; p <0.001 with an r 2 =0.44; p=0.001). Diagnostic accuracy was satisfactory, with 80.8% sensitivity and 85.2% specificity., Conclusion: The Brazilian version of the SATIS-Stroke questionnaire exhibited adequate reliability, concurrent validity, and diagnostic accuracy. Therefore, this is a valid, reproducible measure for the assessment of satisfaction with regard to activities and participation following a stroke., Competing Interests: Conflict of interest The authors declare no conflicts of interest., (Copyright © 2021 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

To appraise available International Classification of Functioning, Disability and Health (ICF)-based tools for the measurement of participation after stroke and to examine their applicability in the African sociocultural context. Pubmed/Medline, Science Direct, Cochrane Library, and Hinari databases were systematically searched. The literature search was limited to studies published in the English or French language from January 2001 up to May 2019. Two reviewers independently screened all identified studies and selected eligible articles. Disagreements about inclusion or exclusion of studies were resolved by consensus. Two reviewers independently extracted the psychometric properties of each instrument using the Consensus-based Standard for the Selection of Health Measurement Instruments checklist and examined the methodological quality of each selected study using the MacDermid checklist. A total of 1030 articles were systematically reviewed for relevance, yielding 22 studies that met inclusion criteria. These studies were related to nine participation tools. The MacDermid scores ranged from 13 to 21 out of 24. The number of investigated psychometric properties and the number of ICF participation domains covered by each tool varied among studies. This systematic review revealed nine ICF-based tools for the measurement of participation after stroke. We examined the content of these tools and provided valuable information that can be used to guide researchers in Africa in their selection of the most appropriate tool for the measurement of participation after stroke.

Introduction: SATIS-Stroke was developed to measure satisfaction regarding activities and participation among stroke survivors based on the concepts contained in the International Classification of Functioning, Disability, and Health. However, this measure is only available in English and French., Objective: Perform the translation and cross-cultural adaptation of SATIS-Stroke to Brazilian Portuguese and test the preliminary reliability of this measure., Methods: The translation process followed standardized guidelines and consisted of six phases: initial translation, back-translation, analysis of expert committee, test of final version, submission, and assessment of all written reports. To test the preliminary test-retest reliability, the measure was administered by a single observer on two occasions with an interval of 7 to 14 days for the determination of intraobserver agreement and administered again by a second observer for the determination of interobserver agreement. Reliability was analyzed using the intraclass correlation coefficient (ICC 2,1 ) and respective 95% confidence intervals (CI)., Results: All stages of the cross-cultural adaptation process were respected and the final translated version of SATIS-Stroke exhibited semantic, idiomatic, cultural, and conceptual equivalence to the original version. The preliminary analysis revealed excellent intraobserver and interobserver reliability (ICC = 0.93; 95% CI: 0.83-0.97, p = 0.001 and ICC = 0.90; 95% CI: 0.74-0.96; p = 0.001, respectively). The items demonstrated adequate internal consistency, although ceiling and floor effects were considered beyond acceptable standards for some items. In the exploratory factor analysis, three factors were extracted that aggregated more than one construct to each component, but all were related to the "Activities and Participation" component of the International Classification of Functioning, Disability, and Health., Conclusion: The final version of the SATIS-Stroke scale in Brazilian Portuguese proved to be adequate and reliable for use on the Brazilian population. Further studies are underway to give continuity to the validation process and analyze the others measurement properties of the scale in the Brazilian population.

Objective: To investigate responsiveness of the Participation Measurement Scale (PM-Scale) for the measurement of participation of stroke survivors., Design: A 6-month observational study with 3 evaluation time points. Responsiveness of the PM-Scale was investigated over a period of 6 months., Setting: Rehabilitation centers., Participants: Stroke survivors (N =64); mean age ± SD, 56.9±12.6 years; sex, 45 men (70%)., Interventions: Not applicable., Main Outcome Measures: Participants were evaluated using the PM-Scale. The modified Rankin Scale was used to categorize the overall disability level for each participant., Results: The mixed-effect model analysis showed a significant difference in the participation over time (χ 2 =35.04; df=2; P<.001). In addition, the model exhibited significant effects of the sex, age, and disability at enrollment on the subjects' participation levels. Furthermore, the PM-Scale detected different levels of changes in the entire cohort over time (small change, effect size [ES]=0.33; moderate change, ES=0.67; and large change, ES=1). The PM-Scale also facilitated the classification of the participants into discriminative categories such as important improvement (t score≥1.96; 1.8≤ES≤2.13), moderate improvement (0

Objective: To develop a valid stroke-specific tool, named the Participation Measurement Scale (PM-Scale), for the measurement of participation after stroke., Design: Observational study and questionnaire development., Setting: Outpatient rehabilitation centers., Participants: Patients with stroke (N=276; mean age, 58.5±11.1y; 57% men)., Interventions: Not applicable., Main Outcome Measures: Participants completed a 100-item experimental questionnaire of the PM-Scale. Items were scored as "not at all," "weakly," or "strongly." The Hospital Anxiety and Depression Scale was used to evaluate depression, and the modified Rankin Scale was used to categorize the severity of disability on the basis of observation., Results: After successive Rasch analyses using unrestricted partial credit parameterization, a valid, unidimensional, and linear 22-item scale for the measurement of participation was constructed. All 22 items fulfilled the measurement requirements of overall and individual item and person fits, category discrimination, invariance, and local response independence. The PM-Scale showed good internal consistency (person separation index, .93). The test-retest reliability of item difficulty hierarchy (r=.96; P<.001) and patient location (r=.99; P<.001) were excellent. This patient-based scale covers all 9 International Classification of Functioning, Disability and Health domains of participation., Conclusions: The PM-Scale has good psychometric qualities and provides accurate measures of participation in patients with stroke in Africa., (Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Stroke is a major public health problem in developing countries. However, few studies have quantified the functional recovery of stroke patients in sub-Saharan Africa. This study examined the functional recovery of stroke patients in the Republic of Benin., Methods: A total of 68 patients with acute stroke were recruited from hospitals and health centres in Benin. Patients were evaluated at enrolment and 1, 3 and 6 months post-stroke. The ACTIVLIM-Stroke scale, Barthel Index, and modified Rankin Scale were used to assess activity limitations, functional autonomy, and overall level of disability, respectively., Results: Over the 6-month follow-up period, 18 patients died and 9 dropped out. Overall, the 3 measures highlighted progressive and significant functional recovery during the first 6 months. At enrolment, the mean score on ACTIVLIM-Stroke was 16% (standard deviation (SD) 9), indicating that patients were almost totally dependent and unable to perform most activities of daily living. At 6 months, the mean score for activity limitation reached 67% (SD 15) and most patients were able to perform some basic tasks easily. Patients had difficulty with tasks requiring walking and remained unable to perform certain activities requiring manual dexterity., Conclusion: The study sample showed significant functional recovery (~50%) during the first 6 months post-stroke. We recommend the integration of group-based brisk walking into a cost-effective rehabilitation programme as a suitable way to increase functional recovery of chronic stroke patients in sub-Saharan Africa after hospital discharge.

Objective: To calibrate and validate the Benin version of ABILOCO, a Rasch-built scale developed to assess locomotion ability in stroke patients., Design: Prospective study and questionnaire development., Setting: Rehabilitation centers., Participants: Stroke patients (N=230; mean age ± SD, 51.1±11.6 y; 64.3% men)., Intervention: Not applicable., Main Outcome Measures: Participants completed a preliminary list of 36 items including the 13 items of ABILOCO. Items were scored as "impossible," "difficult," or "easy." The mobility subdomain of FIM (FIM-mobility), the Functional Ambulation Classification (FAC), the 6-minute walk test (6MWT), and the 10-meter walk test (10MWT) were used to evaluate and elucidate the validity of the ABILOCO-Benin scale., Results: Successive Rasch analyses led to the selection of 15 items that define a unidimensional, invariant, and linear measure of locomotion ability in stroke patients. This modified version of the ABILOCO scale, named ABILOCO-Benin, showed an excellent internal consistency, with a Person Separation Index of .93, and excellent test-retest reliability with high intraclass correlation coefficients of .95 (P<.001) for item difficulty and .93 (P<.001) for subject measures. It also presented good construct validity compared with FAC, FIM-mobility, 6MWT, and 10MWT (r≥.75, P<.001)., Conclusions: ABILOCO-Benin presents good psychometric properties. It allows valid, reliable, and objective measurements of locomotion ability in stroke patients., (Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: After stroke, deregulated interhemispheric interactions influence residual paretic hand function. Anodal or cathodal transcranial direct current stimulation (tDCS) can rebalance these abnormal interhemispheric interactions and improve motor function., Objective: We explored whether dual-hemisphere tDCS (dual-tDCS) in participants with chronic stroke can improve fine hand motor function in 2 important aspects: precision grip and dexterity., Methods: In all, 19 chronic hemiparetic individuals with mild to moderate impairment participated in a double-blind, randomized trial. During 2 separate cross-over sessions (real/sham), they performed 10 precision grip movements with a manipulandum and the Purdue Pegboard Test (PPT) before, during, immediately after, and 20 minutes after dual-tDCS applied simultaneously over the ipsilesional (anodal) and contralateral (cathodal) primary motor cortices., Results: The precision grip performed with the paretic hand improved significantly 20 minutes after dual-tDCS, with reduction of the grip force/load force ratio by 7% and in the preloading phase duration by 18% when compared with sham. The dexterity of the paretic hand started improving during dual-tDCS and culminated 20 minutes after the end of dual-tDCS (PPT score +38% vs +5% after sham). The maximal improvements in precision grip and dexterity were observed 20 minutes after dual-tDCS. These improvements correlated negatively with residual hand function quantified with ABILHAND., Conclusions: One bout of dual-tDCS improved the motor control of precision grip and digital dexterity beyond the time of stimulation. These results suggest that dual-tDCS should be tested in longer protocols for neurorehabilitation and with moderate to severely impaired patients. The precise timing of stimulation after stroke onset and associated training should be defined.

Background and Purpose: This study describes the development of a Rasch-built scale measuring activity limitations in stroke patients, named ACTIVLIM-Stroke., Method: This new Rasch-built measure was constructed based on stroke patients' perceptions of difficulty in performing daily activities. Patients were recruited from inpatient and outpatient rehabilitation departments in Belgium and Benin. A 73-item questionnaire was completed by 204 participants. A random subsample of 83 subjects was given the questionnaire a second time. Data were analyzed using RUMM2030 software., Results: After successive Rasch analyses, the ACTIVLIM-Stroke questionnaire, a unidimensional and linear 20-item measure of activity limitations, was constructed. All 20 items fulfilled Rasch requirements (overall and individual item fit, category discrimination, invariance, local response independence, and nonredundancy in item difficulty). This simple patient-based scale encompasses a large range of activities related to self-care, transfer, mobility, manual ability, and balance. The ACTIVLIM-Stroke questionnaire exhibited high internal validity, excellent internal consistency, and good crosscultural validity. The test-retest reliability of item difficulty hierarchy (intraclass correlation coefficient=0.99) and patient location (intraclass correlation coefficient=0.92) were both excellent. Furthermore, it showed good external construct validity using correlations with the Functional Independence Measure motor and the Barthel Index and a higher discriminating capacity than either of these widely used indices., Conclusions: The ACTIVLIM-Stroke questionnaire has good psychometric qualities and provides accurate measures of activity limitations in patients with stroke. It is recommended for evaluating clinical and research interventions in patients with stroke, because it provides a higher discrimination and might be more sensitive to change.

Objectives: To report the body functions, activities, and participation of stroke patients, and to investigate the relationships over time with the patients' perceived satisfaction with their level of activity and participation., Design: Descriptive., Setting: Hospital, home., Participants: Stroke patients (N = 45; mean age ± SD, 69 ± 10.7y) assessed by the same examiner., Interventions: Not applicable., Main Outcome Measures: The Stroke Impairment Assessment Set was used to measure body functions, the Mini-Mental State Examination was used to measure cognitive level, and the Depression subscale of the Hospital Anxiety and Depression Scale was used to measure mood level. The ABILHAND and ABILOCO scales were used to measure activity, and the SATIS-Stroke questionnaire was used to measure satisfaction with activities and participation. Social and physical environmental factors were assessed by the World Health Organization International Classification of Functioning, Disability and Health Checklist Version 2.1a Clinician form. checklist. Patients were assessed during the acute (1 wk), postacute (3 mo), and chronic (6 mo) phases after stroke onset., Results: Significant changes were observed over time in stroke body functions, cognitive status, manual and locomotion abilities, and satisfaction with activity and participation. At 1 week, satisfaction with activity and participation was not related to any body functions, activities, or environmental factors. At 3 months, manual ability was the only variable that was significantly related to satisfaction. During the chronic phase, manual ability and body functions were the best predictors of the stroke patient's perceived satisfaction. However, this combination of factors predicted only 43% of the variation in the SATIS-Stroke measures., Conclusions: Satisfaction with activity and participation cannot simply be inferred from body functions and activities, because it depends on complex interactions between functional, personal, and environmental factors., (Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To test the tactile spatial resolution in chronic unilateral brain lesions. Additionally, since sensory deficits are thought to have an impact on motor deficits, this study investigated the correlation between tactile spatial resolution and finger dexterity., Design: Descriptive cross-sectional study., Patients: Twenty-two patients with unilateral brain lesions (12 children with congenital hemiplegia and 10 patients after stroke)., Methods: Tactile spatial resolution was measured with a grating orientation task, and finger dexterity with the Purdue Pegboard Test., Results: Major tactile spatial resolution deficits were measured on the paretic hand and preserved abilities on the non-paretic hand, both in children with congenital hemiplegia and in patients after stroke. No correlation was found between the deficits of tactile spatial resolution and digital dexterity in the paretic hand (r = 0.126; p = 0.572)., Conclusion: The specific location of tactile spatial resolution deficits on the hand contralateral to the lesion was surprising when one considers the left hemispheric dominance of tactile spatial resolution in healthy subjects. The absence of correlation between tactile spatial resolution and dexterity deficits suggest that these abilities are not related, suggesting that they should be considered separately and equally integrated into the rehabilitation of unilateral brain lesions.

Objective: To develop a questionnaire (ABILOCO), based on the Rasch measurement model, that can assess locomotion ability in adult stroke patients (International Classification of Functioning, Disability and Health activity domain)., Design: Prospective study and questionnaire development., Setting: A faculty hospital., Participants: Adult stroke patients (N=100) (age, 64+/-15y). The time since stroke ranged from 1 to 260 weeks., Intervention: A preliminary questionnaire included 43 items representing a large sample of locomotion activities. This questionnaire was tested on the 100 stroke patients, and their responses were analyzed using the Rasch model (RUMM 2020 software) to select items that had an ordered rating scale and fitted a unidimensional model., Main Outcome Measure: The ABILOCO questionnaire., Results: The retained items resulted in a 13-item questionnaire, which includes a wide range of locomotion abilities well targeted to the sample population, leading to good reliability (R=.93). The item calibration was independent of age, sex, time since stroke, and affected side. The concurrent validity of ABILOCO was also investigated by comparing it with well-known, criterion standard scales (Functional Walking Category, Functional Ambulation Categories, item 12 of the FIM instrument evaluating walking ability) and the walking speed measured with the 10-meter walk test., Conclusions: The ABILOCO questionnaire presents good psychometric qualities to measure locomotion ability in adult stroke patients. Its range and measurement precision make it attractive for clinical use throughout the rehabilitation process and for clinical research.

Background and Purpose: Chronic hemiparetic patients often retain the ability to manage activities requiring both hands, either through the use of the affected arm or compensation with the unaffected limb. A measure of this overall ability was developed by adapting and validating the ABILHAND questionnaire through the Rasch measurement model. ABILHAND measures the patient's perceived difficulty in performing everyday manual activities., Methods: One hundred three chronic (>6 months) stroke outpatients (62% men; mean age, 63 years) were assessed (74 in Belgium, 29 in Italy). They lived at home and walked independently and were screened for the absence of major cognitive deficits (dementia, aphasia, hemineglect). The patients were administered the ABILHAND questionnaire, the Brunnström upper limb motricity test, the box-and-block manual dexterity test, the Semmes-Weinstein tactile sensation test, and the Geriatric Depression Scale. The brain lesion type and site were recorded. ABILHAND results were analyzed with the use of Winsteps Rasch software., Results: The Rasch refinement of ABILHAND led to a change from the original unimanual and bimanual 56-item, 4-level scale to a bimanual 23-item, 3-level scale. The resulting ability scale had sufficient sensitivity to be clinically useful. Rasch reliability was 0.90, and the item-difficulty hierarchy was stable across demographic and clinical subgroups. Grip strength, motricity, dexterity, and depression were significantly correlated with the ABILHAND measures., Conclusions: The ABILHAND questionnaire results in a valid person-centered measure of manual ability in everyday activities. The stability of the item-difficulty hierarchy across different patient classes further supports the clinical application of the scale.