Reliability and Validity of the Upper-Extremity Motor Activity Log-14 for Measuring Real-World Arm Use

TLDR

The Motor Activity Log (MAL) is a structured interview used in Constraint‑Induced Movement therapy studies to evaluate how stroke survivors use their more‑impaired arm outside the laboratory. This article examines the psychometric properties of the 14‑item MAL in two chronic stroke samples with mild‑to‑moderate upper‑extremity hemiparesis. The study involved two cohorts: 41 participants completed MALs before and after CI therapy or a placebo, with caregivers also completing MALs, and 27 participants completed MALs and wore accelerometers for 3 days before and after automated CI therapy. The participant QOM scale showed strong validity, internal consistency (α > 0.81), test‑retest reliability (r > 0.91), stability, and responsiveness (ratio > 3), with correlations of 0.70–0.91 to caregiver scores and accelerometer data, whereas the AOU and caregiver scales were internally consistent but not reliable.

Abstract

Background and Purpose— In research on Constraint-Induced Movement (CI) therapy, a structured interview, the Motor Activity Log (MAL), is used to assess how stroke survivors use their more-impaired arm outside the laboratory. This article examines the psychometrics of the 14-item version of this instrument in 2 chronic stroke samples with mild-to-moderate upper-extremity hemiparesis. Methods— Participants (n=41) in the first study completed MALs before and after CI therapy or a placebo control procedure. In addition, caregivers independently completed a MAL on the participants. Participants (n=27) in the second study completed MALs and wore accelerometers that monitored their arm movements for 3 days outside the laboratory before and after an automated form of CI therapy. Results— Validity of the participant MAL Quality of Movement (QOM) scale was supported. Correlations between pretreatment-to-posttreatment change scores on the participant QOM scale and caregiver MAL QOM scale, caregiver MAL amount of use (AOU) scale, and accelerometer recordings were 0.70, 0.73, and 0.91 ( P <0.01), respectively. Internal consistency ( α >0.81), test-retest reliability ( r >0.91), stability, and responsiveness (ratio >3) of the participant QOM scale were also supported. The participant AOU and caregiver QOM and AOU scales were internally consistent, stable, and sensitive, but were not reliable. Conclusions— The participant MAL QOM scale can be used exclusively to reliably and validly measure real-world, upper-extremity rehabilitation outcome and functional status in chronic stroke patients with mild-to-moderate hemiparesis.