Chedoke Arm and Hand Activity Inventory (CAHAI)

Purpose

The Chedoke Arm and Hand Activity Inventory (CAHAI) is a functional assessment of the recovering arm and hand after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The CAHAI compliments the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment (Barreca, Stratford, Masters, Lambert, Griffiths, and McBay, 2006).

In-Depth Review

Purpose of the measure

The Chedoke Arm and Hand Activity Inventory (CAHAI) is a functional assessment of the recovering arm and hand after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The CAHAI compliments the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment (Barreca, Stratford, Masters, Lambert, Griffiths, and McBay, 2006).

Available versions

The CAHAI was developed by Barreca, Gowland, Stratford, Huijbregts, Griffiths, Torresin, Dunkley, Miller, and Masters in 2004 to address the need for a valid, clinically relevant, and responsive functional assessment of the recovering paretic upper limb.

Three shortened versions of the CAHAI were developed by Barreca, Stratford, Masters, Lambert, Griffiths, and McBay in 2006. The shortened versions have 7, 8 or 9 items and are identified as CAHAI-7, CAHAI-8, CAHAI-9, respectively.

Features of the measure

Items:

The original CAHAI consists of 13 functional items that are non-gender specific, involve both upper limbs, and incorporates a range of movements and grasps that reflect stages of motor recovery following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The following items were generated from a review of the scientific literature on strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., as well as from input from individuals with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their families (Barreca et al., 2004):

1. Open a jar of coffee
2. Dial 911
3. Draw a line with a ruler
4. Pour a glass of water
5. Wring out a washcloth
6. Do up five buttons
7. Dry back with a towel
8. Put toothpaste on a toothbrush
9. Cut medium consistency putty
10. Clean eye glasses
11. Zip up a zipper
12. Place a container on a table
13. Carry a bag up the stairs

The CAHAI-7 utilizes the first 7 items, CAHAI-8 the first 8 items, and CAHAI-9 the first 9 items. The 13 items together represent the original CAHAI (Barreca et al., 2006). On average, clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. consider items 1, 2, 4 and 12 easy to perform; items 8, 10, 11, and 13 moderately difficult; and items 3, 6, 7, and 9 the most difficult (Barreca et al., 2004).

Detailed administration guidelines are in the development manual that can be obtained can be obtained by visiting the official website: http://www.cahai.ca

Scoring:

Each item of the CAHAI is scored on a 7-point quantitative scale, similar to the scale used in the Functional Independence Measure (FIM) (Keith, Granger, Hamilton, & Sherwin, 1987)

A score of

• 1 = client needs total assistance and the weak upper limb performs less than 25% of the task;
• 2 = client needs maximal assistance and the weak upper limb performs 25% to 49% of the task. There are no signs of arm or hand manipulation, only stabilization;
• 3 = client needs moderate assistance and the weak upper limb performs 50% to 74% of the task. Begins to show signs of arm or hand manipulation;
• 4 = client needs minimal assistance (light touch) and the weak upper limb performs more than 75% of the task;
• 5 = client requires supervision, coaxing, or cueing;
• 6 = client requires use of assistive devicesAssistive devices are any piece of equipment that you use to make your daily activities easier to perform.
  or requires more than reasonable time, or there are safety concerns; and
• 7 = total independence in completing the task.

The minimal possible score for the CAHAI is 13 and the maximum is 91, with higher scores indicating greater functional independence (Barreca et al., 2004; Barreca, Stratford, Lambert, Masters, & Streiner, 2005; Barreca, Stratford, Masters, Lambert, & Griffiths, 2006b).

The affected limb is also scored according to its positioning and functioning during test performance. The therapist should record the performance of the affected limb on each item by checking the appropriate box. The scoring table for the CAHAI is as follows: (Barreca et al., 2004):

Items	Affected Limb
1) Open a jar of coffee	Holds jar	Holds lid
2) Call 911	Holds receiver	Dials phone
3) Draw a line with ruler	Holds ruler	Holds pen
4) Put toothpaste on toothbrush	Holds toothpaste	Holds brush
5) Cut medium consistency putty	Holds knife	Holds fork
6) Pour a glass of water	Holds glass	Holds pitcher
7) Clean a pair of eyeglasses	Holds glasses	Wipes lenses
8) Zip up the zipper	Holds zipper	Holds zipper pull
9) Dry back with towel	Reaches for towel	Grasps towel end

Note: Standardized instructions on scoring can be obtained by visiting the official website: http://www.cahai.ca

Time:

The time to administer and score the CAHAI is approximately 25 minutes (Barreca et al., 2004; Barreca et al., 2006).

Subscales:

None

Equipment required:

CAHAI-7

Version (Items 1-7) requires all items in Equipment List A

Equipment List A

• height adjustable table
• chair/wheelchair without armrests
• dycem
• 200g jar of coffee
• push-button telephone
• 12″/30cm ruler
• 8.5″ x 11″ paper
• pencil
• 2.3L plastic pitcher with lid filled with 1600 ml. Water
• 250 ml plastic cup
• wash cloth
• wash basin (24.5 cm. in diameter, height 8 cm.)
• Pull-on vest with 5 buttons (one side male & one side female), buttons (1.5 cm. In diameter, 7 cm. apart)
• bath towel (65cm X 100cm)

CAHAI-8

Version (Items 1-8) requires all items in Equipment List A and B

Equipment List B

• 75ml toothpaste with screw lid, >50% full
• toothbrush

CAHAI-9

Version (Items 1-9) requires all items in Equipment List A, B, and C

Equipment List C

• dinner plate (Melamine or heavy plastic, 25 cm. in diameter)
• medium resistance putty
• knife and fork
• built up handles the length of the utensil handle

CAHAI-13

Version (Items 1-13) requires all items in Equipment List A, B, C, and D

Equipment List D

• 27″/67cm metal zipper in polar fleece poncho
• eyeglasses
• handkerchief
• Rubbermaid 38L container (50 x 37 x 27cm)
• 4 standard size steps with rail
• plastic grocery bag holding 4lb/2kg weight

Training:

Training may be provided by the authors as a half-day workshop. There is a training DVD available in English for a cost of $29.00 Canadian including shipping. Only cheque or money orders are processed.

Alternative forms of the CAHAI

CAHAI-7, CAHAI-8, CAHAI-9

Client suitability

Can be used with:

• Clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Should not be used in:

• To date, there is no information on restrictions of using the CAHAI.

In what languages is the measure available?

English, French, German, Hebrew, Italian

Summary

What does the tool measure?	The CAHAI assess upper limb functional recovery.
What types of clients can the tool be used for?	The CAHAI can be used with, but is not limited to clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment
Time to administer	An average of 20 to 25 minutes
Versions	CAHAI, CAHAI-9, CAHAI-8, CAHAI-7.
Other Languages	English, French, German, Hebrew and Italian.
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.: Two studies have examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the CAHAI and its shortened versions and reported excellent internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. using Cronbach’s alpha. Test-retest: One study examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). of the CAHAI and reported excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). using using the Intraclass Correlation Coefficient (ICC)Intraclass correlation (ICC) is used to measure inter-rater reliability for two or more raters. It may also be used to assess test-retest reliability. ICC may be conceptualized as the ratio of between-groups variance to total variance.. Intra-rater: No studies have examined the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings. of the CAHAI. Inter-rater: One study examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. of the CAHAI and reported excellent inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. using ICC.
ValidityThe degree to which an assessment measures what it is supposed to measure.	Content: One study examined the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension. of the CAHAI and reported that items were generated from a review of scientific literature and from input from clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., their family and caregivers. Items with poor frequency endorsement, difficulty to be standardized, and high inter-item correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. were eliminated. Criterion: Concurrent: One study examined the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.” of the CAHAI and the CAHAI-9 and reported that the CAHAI-9 was not able to predict individual scores and individual change scores of the CAHAI, using regression analysis. Predictive: No studies have examined the predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks. of the CAHAI. Construct: Convergent: Three studies examined convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other. of the CAHAI and reported excellent correlations between all versions of the CAHAI and the Action Research Arm Test, and all versions of the CAHAI and the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment (CMSA), and poor to moderate correlations between the CAHAI and the CMSA shoulder pain score, using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. . Known Groups: Three studies examined longitudinal/known groups validityThe degree to which an assessment measures what it is supposed to measure. of all versions of the CAHAI and reported that all versions are able to distinguish changes between subjects with acute and chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., and mild from severe impairments, using ROC curve (Receiver Operation Characteristic).
Floor/Ceiling Effects	No studies have examined the floor/ceiling effects of the CAHAI.
SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.” / SpecificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).	No studies have examined the sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.” /specificity of the CAHAI.
Does the tool detect change in patients?	One study examined the responsivenessThe ability of an instrument to detect clinically important change over time. of the CAHAI and reported that the minimal detectable change between two evaluations in stable patients was 6.3 points.
Acceptability	The CAHAI is highly accepted by clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. since is made up of real-life and non-gender specific items.
Feasibility	The administration of the CAHAI is easy and quick to perform.
How to obtain the tool?	The CAHAI can be obtained free of charge by visiting the official website: http://www.cahai.ca

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Chedoke Arm and Hand Activity Inventory (CAHAI) in individuals with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. We identified four studies. The CAHAI appears to be responsive in clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Floor/Ceiling Effects

No studies have examined floor/ceiling effects of the CAHAI.

Reliability

Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.:
Barreca, Gowland, Stratford, Huijbregts, Griffiths, Torresin, Dunkley, Miller, and Masters (2004) assessed the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the CAHAI in 100 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the CAHAI, as calculated using Cronbach’s Coefficient Alpha was excellent (α = 0.98).

Barreca, Stratford, Masters, Lambert, Griffiths, and McBay (2006) examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the CAHAI-7, CAHAI-8, and CAHAI-9 in 39 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of all shortened versions of the CAHAI, as calculated using Cronbach’s Coefficient Alpha, was excellent (α = 0.97; α = 0.98; α = 0.98, respectively).

Test-retest:
Barreca et al. (2006) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the shortened version of the CAHAI in 39 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Participants were stratified into two different groups based on the amount of expected improvement. Participants were re-assessed following a 36 hour interval. The test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
as calculated using Intraclass Correlation Coefficient (ICC)Intraclass correlation (ICC) is used to measure inter-rater reliability for two or more raters. It may also be used to assess test-retest reliability. ICC may be conceptualized as the ratio of between-groups variance to total variance. was excellent for all shortened versions: CAHAI-7 (ICC = 0.96), CAHAI-8 (ICC = 0.97), and CAHAI 9 (ICC = 0.97).

Intra-rater:
No studies have examined the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
of the CAHAI.

Inter-rater:
Barreca, Stratford, Lambert, Masters, and Streiner (2005) assessed the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the CAHAI in 39 clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Participants were stratified into two different groups based on the amount of expected improvement. Participants were re-assessed following a 36 hours interval. The inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
as calculated using Intraclass Correlation Coefficient (ICC)Intraclass correlation (ICC) is used to measure inter-rater reliability for two or more raters. It may also be used to assess test-retest reliability. ICC may be conceptualized as the ratio of between-groups variance to total variance., was excellent (ICC = 0.98).

Validity

Content:

Barreca et al. (2004) performed a literature review to generate items for the CAHAI. From this review, 177 items were selected. Eighty-one clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., their families and caregivers were surveyed about important and relevant items regarding strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. recovery, which generated an additional 574 items. To reduce the 725 generated items to 26 items, only bilateral, gender-neutral items, that fell into the domains identified by the clients as important that were easy to obtain were kept. This version, with 26 items, was then tested in 20 participants with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Items that were difficult to standardize or those with the potential for safety concerns were eliminated. Items with a high degree of difficulty were added in order to minimize possible ceiling effects. Inter-item correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
analyses of this new version (which contained 25 items), identified some redundant items (r > 0.90). Items with poor frequency endorsement, difficulty to standardize and high inter-item correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
were eliminated, resulting in the 13 finalized items.

Criterion:

Concurrent:
Barreca, Stratford, Masters, Lambert, & Griffiths (2006b) examined the ability of the CAHAI-9 to predict the scores and change scores of the original CAHAI in 105 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Mean scores and mean change scores of the CAHAI-9 accurately predicted means scores and mean change scores of the CAHAI. However, individual scores and individual change scores of the CAHAI-9 displayed moderate variability in predicting individual scores and change scores of CAHAI. The findings indicate that the CAHAI-9 should not be administered with the intent to predict the CAHAI.

Predictive:
No studies have examined the predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the CAHAI.

Construct:

Convergent/Discriminant:
Barreca et al. (2005) estimated convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the CAHAI by comparing it to Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment (CMSA – Gowland, Stratford, Ward, Moreland Torresin, VanHullenaar et al., 1993; Gowland, VanHullenaar, Torresin, et al., 1995) arm-hand sum score, and with the Action Research Arm Test (ARAT – Lyle, 1981) in 39 participants with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Assessments were performed at baseline and 2 to 6 weeks later. Correlations, as calculated using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficient were excellent between the CAHAI and the ARAT (r = 0.93) and between the CAHAI and the CMSA arm-hand at baseline (r = 0.81) and at follow up (r = 0.89). In the same study, the authors analyzed discriminant validityMeasures that should not be related are not. Discriminant validity examines the extent to which a measure correlates with measures of attributes that are different from the attribute the measure is intended to assess.
of the CAHAI by comparing it to the CMSA shoulder pain score in the same 39 participants with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the CAHAI and CMSA shoulder pain score as calculated using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
, was adequate at baseline (r = 0.47) and at follow-up (r = 0.39).

Barreca et al. (2006) assessed the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the CAHAI-7, CAHAI-8 and CAHAI-9 by comparing them to the Action Research Arm Test (ARAT), CAHAI and CMSA in 39 individuals with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Pearson Correlations were used. Correlations between the ARAT and CAHAI-7 (r = 0.95), CAHAI-8 (r = 0.95) and CAHAI-9 (r = 0.94) were all excellent , as well as between the CAHAI and all the shortened versions (r = 0.99), and between the CMSA and CAHAI-7 (r = 0.85), CAHAI-8 (r = 0.84), and CAHAI-9 (r = 0.84).

Barreca et al., (2006b) determined the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the CAHAI-9 and CAHAI by comparing them to the ARAT (Lyle, 1981) in 105 individuals with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Re-assessments were performed with a 36 hours interval. Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficients were excellent between the CAHAI-9 and ARAT at baseline (r = 0.93), and at follow-up (r = 0.95), as well as between the CAHAI at baseline (r = 0.93), and at follow-up (r = 0.95).

Known groups:
Barreca et al. (2005) analyzed the longitudinal validityLongitudinal validity is the extent to which changes on one measure will correlate with changes on another measure.
of the CAHAI in 39 clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. by comparing change scores on the CAHAI with change scores on the arm-hand sum and on the shoulder pain dimensions of the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment (CMSA – Gowland et al., 1995) and on the Action Research Arm Test (ARAT – Lyle, 1981). Change scores correlations, as calculated using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficient, was excellent between the CAHAI and the ARAT (r = 0.86), adequate between the CAHAI and the CMSA arm-hand sum (r = 0.52) and poor between the CAHAI and the CMSA shoulder pain (r = -0.24). In a second analysis, Barreca et al. (2005) analyzed whether the CAHAI was more adept then the CMSA and the ARAT at distinguishing change in patients with mild/moderate impairments from patients with severe impairments in 39 clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Longitudinal/known groups validityThe degree to which an assessment measures what it is supposed to measure.
, as calculated using Receiver Operating Characteristic (ROC) demonstrated an excellent area under the curve for the CAHAI (ROC = 0.95). The ARAT and CMSA presented an adequate area under the curve (ROC = 0.88; ROC = 0.76), respectively.
Note: ROC curve analysis quantifies a measure’s ability to distinguish between groups as an area under the ROC curve. Greater areas indicate the measure is better at discriminating between individuals in the two groups.

Barreca et al. (2006) assessed the longitudinal validityLongitudinal validity is the extent to which changes on one measure will correlate with changes on another measure.
of the CAHAI and its three shortened versions in 39 participants with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Participants were divided according to stroke’s severity into acute and chronic groups. The CAHAI, CAHAI-7, CAHAI-8, and CAHAI-9 were administered at admission and discharge (2 to 6 weeks after admission) to verify which version was more adept to detecting changes in patients with acute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. from patients with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Longitudinal/known groups validityThe degree to which an assessment measures what it is supposed to measure.
, as calculated using Receiver Operating Characteristic (ROC) demonstrated an excellent area under the curve for all versions of the CAHAI as follows: CAHAI (ROC = 0.95); CAHAI -7 (ROC = 0.97); CAHAI-8 (ROC = 0.93), and CAHAI-9 (ROC = 0.94), meaning all versions of CAHAI are equally able to distinguish changes between different groups in strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Barreca et al. (2006b) examined the longitudinal validityLongitudinal validity is the extent to which changes on one measure will correlate with changes on another measure.
of the CAHAI, CAHAI-9 and the ARAT in 105 individuals with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Participants were stratified between mild/moderate impairments and severe impairments, and those with mild/moderate impairments were expected to show greater changes across two repeated measures. The three outcome measures were administered at two points in time to verify which of them were more adept to detecting changes in clients with mild/moderate impairment from clients with severe impairment. Longitudinal/known groups validityThe degree to which an assessment measures what it is supposed to measure.
, as calculated using Receiver Operating Characteristics, were adequate for the ARAT (ROC = 0.72), the CAHAI -9 (ROC = 0.82), and the CAHAI (ROC = 0.86). This ROC analysis indicated that the CAHAI was the best measure to detect change among patients with mild/moderate impairment from patients with severe impairment.

Responsiveness

Barreca et al. (2005) assessed the minimal detectable change of the CAHAI in 39 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Participants were assessed at two points in time: at admission, and after 2 to 6 weeks. For the CAHAI, the minimal detectable change was 6.3 points, meaning that stable patients displayed random fluctuations of 6.3 CAHAI points or less when assessed on two different occasions.

References

• Barreca, S.R., Gowland, C.K., Stratford, P.W., et al. (2004). Development of the Chedoke Arm and Hand Activity Inventory: Theoretical constructs, item generation, and selection. Topics in Stroke Rehabilitation, 11(4), 31- 42.
• Barreca, S.R., Stratford, P.W., Lambert, C.L., Masters, L.M., & Streiner, D.L. (2005). Test-retest reliability, validity, and sensitivity of the Chedoke Arm and Hand Activity Inventory: a new measure of upper-limb function for survivors of stroke. Archives of Physical Medicine and Rehabilitation, 86, 1616-1622.
• Barreca, S.R., Stratford, P.W., Masters, L.M., Lambert, C.L., Griffiths, J., McBay, C. (2006). Validation of three shortened versions of the Chedoke Arm and Hand Activity Inventory. Physiotherapy Canada, 58, 148-156.
• Barreca, S.R., Stratford, P.W., Masters, L.M., Lambert, C.L., Griffiths, J. (2006b). Comparing two versions of the Chedoke Arm and Hand Activity Inventory with the Action Research Arm Test. Physical Therapy, 86(2), 245-253.
• Gowland, C., Stratford, P., Ward, M., Moreland, J., Torresin, W., VanHullenaar, S. et al.(1993). Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke, 24,58-63.
• Gowland, C., VanHullenaar, S., Torresin, W., et al. (1995). Chedoke-McMaster Stroke Assessment: development, validation, and administration manual. Hamilton, ON, Canada: School of Rehabilitation Science, McMaster University.
• Heller, A., Wade, D.T., Wood, V.A., Sunderland, A., Hewer, R., & Ward, E. (1987). Arm function after stroke: measurement and recovery over the first three months. Journal of Neurology, Neurosurgery & Psychiatry, 50(6), 714-719.
• Keith, R.A, Granger, C.V., Hamilton, B.B., & Sherwin, F.S. (1987). The Functional Independence Measure: a new tool for rehabilitation. In: Eisenberg, M.G. & Grzesiak, R.C. (Ed.), Advances in clinical rehabilitation (pp. 6-18). New York: Springer Publishing Company.
• Kellor, M., Frost, J., Silberberg, N., Iversen, I., & Cummings R. (1971). Hand strength and dexterity. American Journal of Occupational Therapy, 25, 77-83.
• Lyle, R.C. (1981). A performance test for assessment of upper limb function in physical rehabilitation treatment and research. International Journal of Rehabilitation and Research, 4, 483-492.
• Mathiowetz, V., Kashman, N., Volland, G., Weber, K., Dowe, M., & Rogers, S. (1985). Grip and pinch strength: normative data for adults. Archives of Physical and Medicine and Rehabilitation, 66, 69-72.
• Mathiowetz, V., Weber, K., Kashman, N., & Volland, G. (1985b). Adult norms for the nine hole peg test of finger dexterity. Occupational Therapy Journal of Research, 5, 24 -33.

See the measure

How to obtain the CAHAI

The CAHAI can be obtained free of charge by visiting the official website: http://www.cahai.ca