Reliability, Responsiveness, and Validity of Timed, Large Amplitude, Rapid Alternating Movement Patterns among Patients with Stroke

Objective: The purpose of this study was to investigate the adequacy of timed large amplitude rapid alternating movement patterns (RAMPs) as a measure of motor status following stroke. We were specifically interested in the reliability (internal consistency), responsiveness, and validity of timed large amplitude RAMPs. Design: A retrospective, descriptive, and correlational study. Setting: Inpatient rehabilitation unit of a university hospital. Subjects: The records of 91 patients with a primary diagnosis of stroke were retrieved for this study. Of these records, 32 were complete enough upon admission and discharge for use in this study. Main Outcome Measures: Large amplitude RAMP measures were obtained for each upper and lower extremity using a digital stopwatch. Additionally, the strength of eight muscle actions was assessed bilaterally using hand-held dynamometry. Functional independence of three activities (transfers, gait, and stair climbing) was graded using the Functional Independence Measure (FIM). A sum FIM score was then obtained by adding the score of the three activities together. Results: The timed large amplitude RAMPs were found to have good reliability (alpha>.80) at both admission and discharge. There was a significant difference in RAMP scores between admission and discharge (F=41.824, p<.001), demonstrating that the RAMPs were responsive. Discriminant and convergent construct validity were good. Predictive validity varied depending on the RAMP and outcome measures correlated. Conclusions: Use of large amplitude RAMPs in the examination of patients with stroke is supported by their reliability, responsiveness, and validity.