Frenchay Arm Test (FAT)

Purpose

The Frenchay Arm Test (FAT) is a measure of upper extremity proximal motor control and dexterity during ADL performance in patients with impairments resulting from neurological conditions. The FAT is an upper extremity specific measure of activity limitation.

In-Depth Review

Purpose of the measure

The Frenchay Arm Test (FAT) is a measure of upper extremity proximal motor control and dexterity during ADL performance in patients with impairments of the upper extremity resulting from neurological conditions. The FAT is an upper extremity specific measure of activity limitation.

Available versions

None typically reported.

Features of the measure

Description of tasks:

Clients sit comfortably at a table with hands on their lap; each test item starts from this position. Clients are then asked to use their affected arm to:

• Stabilize a ruler, while drawing a line with a pencil held in the other hand. To pass, the ruler must be held firmly.
• Grasp a cylinder (12 mm diameter, 5 cm long), set on its side approximately 15 cm from the table edge, lift it about 30 cm and replace it without dropping.
• Pick up a glass, half full of water positioned about 15 to 30 cm from the edge of the table, drink some water and replace without spilling.
• Remove and replace a sprung clothes peg from a 10mm diameter dowel, 15 cm long set in a 10 cm base, 15 to 30 cm from table edge. Not to drop peg or knock dowel over.
• Comb hair (or imitate); must comb across top, down the back and down each side of head.

What to consider before beginning:

• Before administering the FAT, the clinician should ensure that the client is able to comprehend either written or spoken language.
• The FAT has been criticized for lacking assessment of quality of movement and performance (Kopp, 1997). In addition, clients were found to either pass or fail all or most subtests, indicating that the FAT may not be sensitive to change or subtleties in progress (Hsieh, Hsueh, Chiang & Lin, 1998), especially in clients performing in the upper range of arm function (Wade, et al., 1983).

Scoring and Score Interpretation:

Each item is scored as either pass (=1) or fail (=0). Total scores range from 0 to 5.

Time:

The FAT takes approximately 3 minutes to administer.

Training requirements:

None typically reported, however familiarity with the measure is recommended.

Equipment:

• Ruler
• Pencil
• Paper
• Cylinder (12mm diameter, 5 cm long)
• Glass (Half filled with water)
• Clothes peg
• Dowel (15mm)
• Hair comb

Alternative Forms of the FAT

None typically reported

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:

• Clients with difficulty understanding written and spoken language

Languages of the measure

• English
• French
• Dutch

Summary

What does the tool measure?	The FAT measures upper extremity proximal control and dexterity during performance of functional tasks.
What types of clients can the tool be used for?	The FAT 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	The FAT takes approximately 3 minutes to administer.
Versions	There are no alternative versions of the FAT.
Other Languages	French and Dutch
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 .	Intra-rater: One study 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 FAT 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. and found adequate to excellent 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. . 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 FAT 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. and found 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. .
ValidityThe degree to which an assessment measures what it is supposed to measure.	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). : Two studies compared 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.” of the FAT with that of the Nine-Hole Peg Test (NHPT) and found the NHPT to be more sensitive than the FAT for detecting impaired upper extremity function 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 the floor/ceiling effects of the FAT 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..
Does the tool detect change in patients?	No studies have investigated the responsivenessThe ability of an instrument to detect clinically important change over time. of the FAT 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..
Acceptability	The FAT has been criticized for lacking assessment of quality of movement and performance (Kopp, 1997). In addition, clients were found to either pass or fail all or most subtests, indicating that the FAT may not be sensitive to change (Hsieh, Hsueh, Chiang & Lin, 1998). The FAT is quick to complete and should not produce any undue fatigue for patients.
Feasibility	The FAT is short and easy to administer and score.
How to obtain the tool?	For more information on the FAT, please visit the article by Parker, Wade & Langton Hewer (1986).

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the Frenchay Arm Test (FAT) 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.. Two studies were found and have been reviewed in this module. More studies are required before definitive conclusions can be drawn regarding the 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 .
and validityThe degree to which an assessment measures what it is supposed to measure.
of the FAT.

Floor/Ceiling Effects

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

Reliability

Internal constancy:
No 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 FAT 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..

Intra-rater:
Heller, Wade, Wood, Sunderland, Hewer, and Ward (1987) 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 FAT, Nine-Hole Peg Test (NHPT), Finger Tapping Rate (Lezak, 1983), and Grip Strength (Mathiowetz, Kashman, Volland, Weber, Dowe, & Rogers, 1985) in 10 patients with subacute 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 re-assessed with a 2-week interval by the same rater. In this study, results describe the range of 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 .
of the four measures mentioned above, and values for each individual measure were not provided. Spearman rho 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 adequate to excellent (ranging for all four measures from r = 0.68 to 0.99).
Note: Although is not possible to discern the exact value for the FAT 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 .
, all values were considered adequate to excellent and statistically significant, suggesting that the FAT may be reliable with stable 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. clients.

Inter-rater:
Heller et al. (1987) 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 FAT, Nine-Hole Peg Test (NHPT), Finger Tapping Rate (Lezak, 1983), and Grip Strength (Mathiowetz et al., 1985) in 10 patients with subacute 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 twice within a week by two raters. Spearman rho 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 (ranging for all four measures from r = 0.75 to 0.99).
Note: In this study, individual values for each measure were not provided. Although is not possible to discern the exact value for the FAT 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 .
, all values were considered excellent.

Test-retest:
No studies have 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 FAT 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..

Validity

Content:

No studies have 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 FAT 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..

Criterion:

Concurrent:
No studies have 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 FAT 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..

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 FAT 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..

Construct:

Convergent/Discriminant:
No studies have examined the 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 FAT 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..

Known Groups:
No studies have examined the known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
of the FAT 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..

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:
Heller et al. (1987) investigated the specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the FAT and the Nine Hole Peg Test (NHPT) in 56 clients 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.. All of the clients that scored less than 5/5 on the FAT were correctly identified as having impaired dexterity, as identified by using the normal cut-off scores for the NHPT. However, 48 percent of patients that scored 5/5 on the FAT scored in the below normal range on the Nine Hole Peg Test. These results indicate that the NHPT is more sensitive than the FAT for detecting impaired upper extremity function 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..

Parker, Wade & Hewer (1986) compared the specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the FAT and the Nine-Hole Peg Test (NHPT) in 187 clients with sub-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.. Participants that were able to successfully place nine pegs in the pegboard were further categorized according to those who completed the NHPT in less than 19 seconds (n=37) and those who required over 19 seconds (n=69). For the FAT, 114 participants score 5/5, 33 participants scored in the middle range (1/5 – 4/5) and 36 participants scored 0/5. Researchers concluded that the NHPT is more sensitive than the FAT because 13 percent of participants who scored perfectly on the FAT placed less than 9 pegs on the NHPT and all participants who scored perfectly on the NHPT (9 pegs placed in less than 19 seconds) also scored 5/5 on the FAT.

Responsiveness

No studies have examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the FAT 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..

References

• Heller, A., Wade, D.T., Wood, V.A., Sunderland, A., Langton Hewer, R., & Ward, E. (1987). Arm function after stroke: Measurement and recovery over the first three months. Journal of Neurology, Neurosurgery, and Psychiatry, 50, 714-719.
• Hsieh, C-L., Hsueh, P. Chiang, F-M., & Lin, P-H. (1998). Inter-rater reliability and validity of the Action Research Arm Test in stroke patients. Age and Ageing, 27, 107-113.
• Parker, V.M., Wade, D.T., & Langton Hewer, R. (1986). Loss of arm function after stroke: Measurement, frequency, and recovery. International Rehabilitative Medicine, 8, 69-73.
• Wade, D.T., Langton-Hewer, R., Wood, V.A., Skilbeck, C.E., & Ismail, H.M. (1983). The hemiplegic arm after stroke: Measurement and recovery. Journal of Neurology, Neurosurgery and Psychiatry, 46, 521-524.

See the measure

For more information on the FAT, please review the article by Parker, Wade & Langton Hewer (1986).