Abilhand-stroke: validation of the Beninese version
Dr Ditouah Didier NIAMA NATTAa, Dr Etienne ALAGNIDEb, Prof Toussaint KPADONOUb, Prof Christine DETREMBLEURa, Prof Thierry LEJEUNEc, Prof Gaetan STOQUARTc
a Université Catholique de Louvain, Institut de Neuroscience, b Service de Rééducation et de Réadaptation Fonctionnelle du Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA (CNHU-HKM) de Cotonou, c Université catholique de Louvain, Cliniques universitaires saint-Luc, Service de Médecine Physique et Réhabilitation de Bruxelles
Background and objective. Stroke upper limb paresis affects the ability to engage successfully in activities of daily living. ABILHAND-Stroke is a self-reported questionnaire, designed for stroke patients, that assesses bimanual activities. It has been developed and validated in Belgium. This study aims to validate ABILHAND-Stroke for Beninese subjects.
Methods. The first step consisted to evaluate the content validity of 56 original items of ABILHAND-stroke, to obtain the preliminary Beninese version. Two items were taken off, three items were modified and five items were added to fit the African context. A version of 59 unimanual and bimanual items was submitted to 155 chronic stroke patients. Patients were asked to rate their perceived difficulty in performing each activity on a 4-level scale: “impossible”, “very difficult”, “difficult” or “easy”. Additional measures included: Box and Block Test (BBT), Functional Independence Measure (motor subscale FIM-motor), Stroke Impairment Assessment Scale (SIAS) and ACTIVLIM-Stroke. Data were analyzed with RUMM2030 and Sigma-Stat softwares.
Results and discussion. The Rasch analysis showed that the categories “very difficult” and “difficult” were not well discriminated by patients, that 34 unimanual items were very easy for all patients, that 2 items were not fitting the model, and that two other items were redundant. The final version for ABILHAND-Stroke scale for Beninese subjects consisted of 21 bimanual items, including 3-level of rating. ABILHAND-stroke for Beninese subjects was invariant through different subgroups: age (ICC=0.90, p<0.0001), sex (ICC=0.94, p<0.0001), stroke duration (ICC=0.96, p<0.0001), hemiparetic side (ICC=0.97, p<0.0001), level of depression (ICC=0.88, p<0.0001). This scale showed a high reliability (person separation index=0.95) and measured a large range level of manual ability (6 levels). The study of the concurrent validity demonstrated a significant correlation with SIAS (r=0.71), FIM-motor (r=0.60), BBT (r=0.66) and ACTIVLIM-Stroke (r=0.97).
Conclusion. ABILHAND-Stroke for Beninese subjects can be used to assess the manual ability of chronic stroke patients in Benin and more generally in African French-speaking countries. This scale displays good psychometric properties.
Keywords : stroke, upper limb, activity, scale.