Frenchay Arm Test (FAT)

Evidence Reviewed as of before: 17-09-2012
Author(s): Katie Marvin, MPT
Editor(s): Annabel McDermott, OT

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 stroke

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 stroke.
Is this a screening 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
Reliability

Inter-rater reliability:

One study examined the inter-rater reliability of the FAT in clients with stroke and found excellent

Intra-rater reliability:

One study examined the intra-rater reliability of the FAT in clients with stroke and found adequate to excellent intra-rater reliability.

Validity

Sensitivity/ Specificity

Two studies compared the sensitivity 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 stroke.

Floor/Ceiling Effects No studies have examined the floor/ceiling effects of the FAT in clients with stroke.
Does the tool detect change in patients? No studies have investigated the responsiveness of the FAT in clients with stroke.
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 stroke. Two studies were found and have been reviewed in this module. More studies are required before definitive conclusions can be drawn regarding the reliability and validity of the FAT.

Floor/Ceiling Effects

No studies have examined the floor/ceiling effects of the FAT in clients with stroke.

Reliability

Internal constancy:
No studies have examined the internal consistency of the FAT in clients with stroke.

Intra-rater reliability:
Heller, Wade, Wood, Sunderland, Hewer, and Ward (1987) examined the intra-rater reliability 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 stroke. Participants were re-assessed with a 2-week interval by the same rater. In this study, results describe the range of reliability of the four measures mentioned above, and values for each individual measure were not provided. Spearman rho 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 reliability, all values were considered adequate to excellent and statistically significant, suggesting that the FAT may be reliable with stable stroke clients.

Inter-rater reliability:
Heller et al. (1987) examined the inter-rater reliability 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 stroke. Participants were assessed twice within a week by two raters. Spearman rho 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 reliability, all values were considered excellent.

Test-retest:
No studies have examined the test-retest reliability of the FAT in clients with stroke.

Validity

Content validity

No studies have examined the content validity of the FAT in clients with stroke.

Criterion validity

Concurrent validity:
No studies have examined the concurrent validity of the FAT in clients with stroke.

Predictive validity:
No studies have examined the predictive validity of the FAT in clients with stroke.

Sensitivity/specificity:
Heller et al. (1987) investigated the specificity of the FAT and the Nine Hole Peg Test (NHPT) in 56 clients with chronic stroke. 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 stroke.

Parker, Wade & Hewer (1986) compared the specificity of the FAT and the Nine-Hole Peg Test (NHPT) in 187 clients with sub-acute stroke. 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.

Construct validity

Convergent/Discriminant:
No studies have examined the discriminant validity of the FAT in clients with stroke.

Known Groups:
No studies have examined the known groups validity of the FAT in clients with stroke.

Responsiveness

No studies have examined the responsiveness of the FAT in clients with stroke.

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).

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