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Title: Inter-rater and intra-rater reliability of the Chinese version of the action research arm test in people with stroke
Authors: Zhao, JL
Chen, PM 
Zhang, T
Li, H
Lin, Q
Mao, YR
Huang, DF
Keywords: Stroke
Upper extremity
Action research arm test
Issue Date: 2019
Publisher: Frontiers Research Foundation
Source: Frontiers in neurology, 29 May 2019, v. 10, 540, p. 1-7 How to cite?
Journal: Frontiers in neurology 
Abstract: Purpose: To detect the inter-rater and intra-rater reliability of the Chinese version of the Action Research Arm Test (C-ARAT) in patients recovering from a first stroke.
Methods: Fifty-five participants (45 men and 10 women) with a mean age of 58.67 +/- 12.45 (range: 22-80) years and a mean post-stroke interval of 6.47 +/- 12.00 (0.5-80) months were enrolled in this study. To determine the inter-rater reliability, the C-ARAT was administered to each participant by two raters (A and B) with varying levels of experience within 1 day. To determine intra-rater reliability, rater A re-administered the C-ARAT to 33 of the 55 participants on the second day. Intra-class correlation coefficients (ICCs) and Bland-Altman plots were used to analyse the inter-rater and intra-rater reliability.
Results: Regarding inter-rater reliability, the total, grasping, gripping, pinching, and gross movement scores received respective ICCs of 0.998, 0.997, 0.995, 0.997, and 0.960 (all p < 0.001) , indicating excellent inter-rater reliability in stroke patients. Regarding intra-rater reliability, the corresponding ICCs were 0.987, 0.980, 0.975, 0.944, and 0.954 (all p < 0.001) , again indicating excellent intra-rater reliability. The Bland-Altman plots yielded a mean difference of 0.15 with 95% limits of agreement (95%LOA) ranging from -2.16 to 2.46 for the inter-rater measurements and a mean difference of -1.06 with 95%LOA ranging from -6.43 to 4.31 for the intra-rater measurement. The C-ARAT thus appeared to be a stable scoring method.
Conclusions: The C-ARAT yielded excellent intra-rater and inter-rater reliability for evaluating the paretic upper extremities of stroke patients. Therefore, our results supported the use of the C-ARAT in this population.
EISSN: 1664-2295
DOI: 10.3389/fneur.2019.00540
Rights: Copyright © 2019 Zhao, Chen, Zhang, Li, Lin, Mao and Huang. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY) ( The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
The following publication Zhao J-L, Chen P-M, Zhang T, Li H, Lin Q, Mao Y-R and Huang D-F (2019) Inter-rater and Intra-rater Reliability of the Chinese Version of the Action Research Arm Test in People With Stroke. Front. Neurol. 10:540, 7 pages is available at
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