ArticleFrontiers in neurology
Reliability, validity, and usability of an 18-item immersive virtual reality action research arm test: a validation study in stroke survivors.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
Background: 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. Objective: 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. Methods: 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). Results: 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 [1.0-1.0]). Regarding concurrent validity, the ARAT-VR scores for the paretic hand strongly correlated with both the 18-item traditional ARAT ( Conclusions: 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.
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