The ArmA questionnaire is a patient and/or carer-reported 20-item measure of difficulty in passive and active hemiparetic arm function. It consists of a seven-item passive function subscale, and 13-item active function subscale. Using a Likert scoring system between 0 (no difficulty) and 4 (unable to do task), the passive function subscale scores range from 0 (high function) to 28 and the active function subscale scores range from 0 (high function) to 52.
How is ArmA rated?
Section A asks about ‘caring’ for your affected arm either yourself with your unaffected arm or by a carer/caregiver or a combination of yourself and the carer/caregiver together. The section does not ask about using your affected arm to complete any of the tasks.
Section B asks what you can do using your affected arm or using both arms together.
For each of the activities listed in the ArmA, the person completing the measure needs to indicate:
- The amount of difficulty that you or your carer/caregiver experience in doing the task, based on your activity over the last seven days. Please estimate if you do the task but have not done so in the last seven days (e.g. for cutting fingernails).
- If the task is never done, but this has nothing to do with your arm or is never done with your affected arm, the score should be 0 = No difficulty.
If you are unable to complete the questionnaire independently, you may:
- Ask a carer/caregiver or professional to write your responses for you
- Ask a carer/caregiver or professional to help you understand and complete the questionnaire, question by question
- Ask a carer/caregiver or professional to respond to the questions on your behalf
Rating of the passive and active subscale items is done on the following scale:
- Level of difficulty
- 0 = No difficulty
- 1 = Mild difficulty
- 2 = Moderate difficulty
- 3 = Severe difficulty
- 4 = Unable to do activity
ArmA was developed to produce a patient reported outcome measure of active and passive function in the hemiparetic upper limb. Potential items for inclusion were identified through:
(a) systematic review and analysis of existing measures, and
(b) analysis of the primary goals for treatment in a spasticity service.
Item reduction was achieved through consultation with a small, purposively selected multi-disciplinary group of experienced rehabilitation professionals (n= 10) in a three-round Delphi process. This was followed by a confirmatory survey with a larger group of clinicians (n= 36) and patients and carers (n= 13 pairs). From an initial shortlist of 75 items, 23 items were initially identified for inclusion in the arm activity measure (ArmA), and subsequently refined to a 20-item instrument comprising 7 passive and 13 active function. In common with the six measures identified in the systematic review, a five-point ordinal scaling structure was chosen, with ratings based on activity over the preceding seven days.
The ArmA is designed to measure passive and active function following focal interventions for the hemiparetic upper limb. Content and face validity have initially been addressed within the development process.
Source references
- Ashford S. Slade M. Siegert, R. Turner-Stokes L. Initial psychometric evaluation of the Arm Activity Measure (ArmA): a measure of activity in the hemiparetic arm. Clinical Rehabilitation. 2013; 27(8): 728-740. DOI: 10.1177/0269215512474942
- Ashford S. Slade M. Turner-Stokes L. Conceptualisation and development of the Arm Activity Measure (ArmA) for assessment of activity in the hemiparetic arm. Disability and Rehabilitation. 2013; 35(18):1513-8. DOI: 10.3109/09638288.2012.743602
- Ashford S, Alexandrescu R & Siegert RJ., The Arm Activity measure (ArmA) passive function sub-scale conjoint measurement and ordinal scaling, Clinical Rehabilitation 2016;30, 714-718
- Ashford S, Siegert RJ & Alexandrescu R., Rasch measurement: The Arm Activity Measure (ArmA) passive function sub-scale, Disability and Rehabilitation 2015
- Ashford S, Slade M, Nair A, Turner-Stokes L & Ashford S., Arm Activity measure (ArmA) application for recording functional gain following focal spasticity treatment, International Journal of Therapy and Rehabilitation, 2015; 21(1), 10-17
- Ashford S, Slade, M. Malaparade, F. Turner-Stokes L. (2008) Evaluation of functional outcome measures for the hemiparetic upper limb – A systematic review. Journal of Rehabilitation Medicine; 2008; 40 (10): 787-795.
Key publications
- Ashford S, Slade M, Nair A, Turner-Stokes L (2014) Arm Activity measure (ArmA) application for recording functional gain following focal spasticity treatment. International Journal of Therapy and Rehabilitation 21(1): 10-17.
- Royal College of Physicians, British Society of Rehabilitation Medicine, Chartered Society of Physiotherapy, and Association of Chartered Physiotherapists Interested in Neurology (2009) Spasticity in adults: management using botulinum toxin. National Guidelines. Royal College of Physicians, London.
The ArmA is used internationally for assisting in goal setting and outcome evaluation for spasticity management and other focal arm and hand rehabilitation interventions.
- Turner-Stokes, L., Jacinto, J., Fheodoroff, K., Brashear, A., Maisonobe, P., Lysandropoulos, A. & Ashford, S., (2021). Assessing the effectiveness of upper-limb spasticity management using a structured approach to goal-setting and outcome measurement: First cycle results from the Upper Limb International Spasticity-III study. Journal of Rehabilitation Medicine. DOI: 10.2340/16501977-2770.
- Turner-Stokes L, Fheodoroff K, Jacinto J, Maisonobe, P. Ashford S, (2019) ULIS (Upper Limb International Spasticituy), a 10-year odyssey. An international, multicenter longitudinal cohort of person-centered spasticity management in real-life practice. The Journal of the International Society of Physical and Rehabilitation Medicine. 2019;2:138-50. DOI 10.156.63.32
- Turner-Stokes L, Balcaitiene J, Ashford S, Jacinto J, Maisonobe P, Fheodoroff K. (2016) Integrated upper limb spasticity management including botulinum toxin A (BoNT-A) on patient-centred goal attainment: Methodology for ULIS-III and initial goal-setting data: TOXINS 2017: Basic Science and Clinical Aspects of Botulinum and Other Neurotoxins. Toxicon. Dec 25;123, Supplement:S81. Available from: 10.1016/j.toxicon.2016.11.224
Translations
Thai
Euawongyarti P. Buntragulpoontawee M. Ashford S. Rapipong J. Wongpakaran T. (2018) Preliminary evaluation of the reliability, validity and feasibility of the Arm Activity Measure – Thai Version (ArmA-TH) in Cerebrovascular Patients with Upper Limb Spasticity. Health and Quality of Life Outcomes. 16:141, doi.org/10.1186/s12955-018-0971-2.
Swedish
Ramström T, Bunketorp-Käll L, Wangdell J. Arm activity measure (ArmA): psychometric evaluation of the Swedish version. J Patient Rep Outcomes. 2021 May 12;5(1):39. doi: 10.1186/s41687-021-00310-4. PMID: 33982227; PMCID: PMC8116475.
French, German and Welsh translations are also being developed.