{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:41:16Z","timestamp":1792172476189,"version":"4.4.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>About 77% of adults with stroke have upper limb impairments. Many scales are available to measure the impairment and activity level of the affected limb. However, an observational scale to assess dependency on others in upper limb performance during daily life activities instead of laboratory settings is lacking. Therefore, we developed a new 5-item Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale (UL-LIMOS). As next step in the psychometric analysis, we evaluated the unidimensionality and structural validity of the UL-LIMOS with Rasch Measurement Theory and we calculated a cut-off score for independent arm use in daily life activities at discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a single-center cross-sectional study in adults with (sub) acute stroke. We applied Rasch Measurement Theory (RMT) to analyze the structural validation and unidimensionality of the UL-LIMOS. The outputs provide evidence of unidimensionality, item and person fit, overall fit, differential item functioning (DIF), principal component analysis of residuals (PCAR), person separation reliability (PSR), and residual item correlations (to identify local item dependence). Person mean location, floor and ceiling effects identify proper targeting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We recruited 407 adults with (sub) acute stroke (median age 63 years, 157 women). All items and persons fit the Rasch model. The PSR of 0.90 indicates that clinicians and researchers can reliably use the scale for individual decision-making. There were small floor (2.70%) and ceiling (13.00%) effects. The average person mean location was 1.32\u2009\u00b1\u20092.99 logits. There was no DIF. PCAR eigenvalue was 2.46 with 49.23% explained variance. Paired\n                      <jats:italic>t<\/jats:italic>\n                      -tests revealed that 0.89% of person locations were significantly different, confirming unidimensionality. One pair of items (arm and hand use and fine hand use) showed residual item correlations. The ROC\u2019s AUC was 0.90, CI\n                      <jats:sub>95%<\/jats:sub>\n                      \u2009=\u2009[0.85\u20130.96] with cut-off score of \u226514\/20, and high sensitivity (87%, CI\n                      <jats:sub>95%<\/jats:sub>\n                      \u2009=\u2009[81%\u201391%]), specificity (83%, CI\n                      <jats:sub>95%<\/jats:sub>\n                      \u2009=\u2009[77%\u201387%]) for independent arm use in daily living at discharge.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The new Rasch-based UL-LIMOS is a valid ICF-based observation performance scale at the ICF-activity level, to evaluate dependency during upper limb use in daily life in adults with stroke. Additional psychometric analyses are warranted. The UL-LIMOS would be a valuable addition to the core assessments of adults with (sub) acute stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2023.1154322","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T08:48:03Z","timestamp":1688978883000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale"],"prefix":"10.3389","volume":"14","author":[{"given":"Ann","family":"Van de Winckel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Ottiger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janne Marieke","family":"Veerbeek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Nyffeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Vanbellingen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1161\/01.STR.32.6.1279","article-title":"Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population","volume":"32","author":"Lawrence","year":"2001","journal-title":"Stroke"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.1161\/STROKEAHA.110.604090","article-title":"Early prediction of outcome of activities of daily living after stroke: a systematic review","volume":"42","author":"Veerbeek","year":"2011","journal-title":"Stroke"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1161\/strokeaha.109.573402","article-title":"Five-year outcome of a stroke cohort in Martinique, French West Indies: Etude Realisee en Martinique et Centree sur l\u2019Incidence des Accidents vasculaires cerebraux, Part 2.","volume":"41","author":"Chausson","year":"2010","journal-title":"Stroke"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1848","DOI":"10.1007\/s00415-010-5622-4","article-title":"Depressive symptoms and quality of life after thrombolysis in stroke: the TEMPiS study","volume":"257","author":"Schwab-Malek","year":"2010","journal-title":"J Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e1909","DOI":"10.1212\/wnl.0000000000006510","article-title":"Return to work after ischemic stroke in young adults","volume":"91","author":"Aarnio","year":"2018","journal-title":"Neurology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s12883-015-0292-6","article-title":"An overview of systematic reviews on upper extremity outcome measures after stroke","volume":"15","author":"Alt Murphy","year":"2015","journal-title":"BMC Neurol"},{"key":"ref7","first-page":"228","volume-title":"International Classification of Functioning, Disability and Health: ICF","year":"2001"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"13","DOI":"10.2340\/1650197771331","article-title":"The post-stroke hemiplegic patient. 1. 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