{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T06:06:38Z","timestamp":1784700398488,"version":"3.55.0"},"reference-count":60,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"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>Background<\/jats:title>\n                    <jats:p>Stroke is a leading cause of adult disability, with upper extremity hemiparesis affecting approximately 80% of survivors. While the Action Research Arm Test (ARAT) is the reference standard for assessing motor function, its clinical use is hindered by being resource-intensive and requiring standardized physical props. Virtual Reality (VR) has emerged as a promising method for automated and objective assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to develop and validate an 18-item immersive VR version of the ARAT (ARAT-VR) and assess its validity, reliability, and usability among stroke survivors, healthcare professionals, and healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty stroke survivors, 30 healthy controls, and eight healthcare professionals were recruited. The ARAT-VR system, developed for the PICO 4 Ultra Enterprise headset, utilizes an iToF depth sensor for controller-free optical hand tracking and retains 18 of the original 19 items. Content validity was evaluated by professionals. Concurrent validity was measured via Spearman's correlation between ARAT-VR and traditional ARAT scores. Test-retest reliability (Intraclass Correlation Coefficient, ICC) was assessed over a 7-day interval. Usability was measured using the System Usability Scale (SUS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Regarding content validity, most of the 18 ARAT-VR items were rated as comparable to physical tasks specifically in visual-motor control demands (Median = 0), except for manipulating minute objects (e.g., 6 mm marbles), which was rated as more difficult (1.0 [1.0\u20131.0]). Regarding concurrent validity, the ARAT-VR scores for the paretic hand strongly correlated with both the 18-item traditional ARAT (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>s<\/jats:sub>\n                      = 0.845, 95% CI: 0.673\u20130.965,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) and the full 19-item ARAT (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>s<\/jats:sub>\n                      = 0.845, 95% CI: 0.696\u20130.961,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Bland-Altman analysis indicated a mean bias of 1.77 points with 95% limits of agreement from \u221210.07 to 13.60. Test-retest reliability was excellent (ICC = 0.98, 95% CI: 0.96\u20130.99,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), with a Minimal Detectable Change (MDC) of 5.36 points, representing the minimum change required to exceed measurement error. Usability was rated as excellent (Median SUS = 85.0 for healthy controls and 81.3 for stroke survivors;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.212).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Initial findings suggest that the 18-item ARAT-VR possesses favorable concurrent validity, high test-retest reliability, and acceptable usability, highlighting its potential as a supplementary digital assessment tool for stroke survivors. The calculated MDC of 5.36 points offers a preliminary reference for future longitudinal monitoring. However, its readiness for routine clinical implementation remains unestablished. Further large-scale studies are necessary to validate the system across broader populations and explore hardware optimizations, such as the integration of haptic feedback.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1876892","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:53:13Z","timestamp":1784699593000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Reliability, validity, and usability of an 18-item immersive virtual reality action research arm test: a validation study in stroke survivors"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhipeng","family":"Pan","sequence":"first","affiliation":[{"name":"School of Rehabilitation, Shandong University of Traditional Chinese Medicine","place":["Jinan, 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