563 JRRD JRRD Volume 47, Number 6, 2010 Pages 563–572 Journal of Rehabilitation Research & Development Responsiveness and validity of three dexterous function measures in stroke rehabilitation Keh-chung Lin, ScD, OTR; 1–2 Li-ling Chuang, PhD, PT; 1 Ching-yi Wu, ScD, OTR; 3* Yu-wei Hsieh, MS; 1 Wan-ying Chang, BS 4 1 School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; 2 Division of Occu- pational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; 3 Graduate Institute of Clinical Behavioral Science and Department of Occupational Therapy, Chang Gung University, Taoyuan, Taiwan; 4 Rehabilitation Department, Taipei Hospital, Department of Health, Taipei, Taiwan Abstract—In this study, we compared the responsiveness and validity of the Box and Block Test (BBT), the Nine-Hole Peg Test (NHPT), and the Action Research Arm Test (ARAT). We randomized 59 patients with stroke into one of three rehabilita- tion treatments for 3 weeks. We administered six outcome mea- sures (BBT, NHPT, ARAT, Fugl-Meyer Assessment [FMA], Motor Activity Log [MAL], and Stroke Impact Scale [SIS] hand function domain) pretreatment and posttreatment. We used the standardized response mean (SRM) to examine responsiveness and the Spearman rank correlation coefficient (rho) to examine concurrent validity. The BBT, NHPT, and ARAT were moderately responsive to change and not signifi- cantly different (SRM = 0.64–0.79). The correlations within the BBT, NHPT, and ARAT were moderate to good at pretreatment (rho = –0.55 to –0.80) and posttreatment (rho = –0.57 to –0.71). The BBT and ARAT showed fair to moderate correlations with the FMA, MAL, and SIS hand function domain at pretreat- ment and posttreatment (rho = 0.31–0.59), whereas the NHPT demonstrated low to fair correlations with the FMA and MAL (rho = –0.16 to –0.33) and moderate correlations with the SIS hand function domain (rho = –0.58 to –0.66). Our results indi- cate that the BBT, NHPT, and ARAT are suitable to detect changes over time. While simultaneously considering the responsiveness and validity attributes, the BBT and ARAT can be considered more appropriate for evaluating dexterous func- tion than the NHPT. Further studies with larger samples are needed to validate these findings. Clinical Trial Registration: ClinicalTrials.gov; Relative Effects and Predictive Models of Contemporary Upper Limb Training Programs in Stroke Patients; NCT00778453; http:// clinicaltrials.gov/ct2/show / NCT00778453?term=NCT00778453&rank=1 . Key words: bootstrapping, cerebrovascular accident, clinimet- rics, dexterity, function, outcome, rehabilitation, responsive- ness, upper limb, validity. Abbreviations: ADL = activity of daily living, AOU = amount of use, ARAT = Action Research Arm Test, BAT = bilateral arm training, BBT = Box and Block Test, CIT = constraint- induced therapy, dCIT = distributed CIT, FMA = Fugl-Meyer Assessment, MAL = Motor Activity Log, NHPT = Nine-Hole Peg Test, SIS = Stroke Impact Scale, SRM = standardized response mean, UL = upper limb, WMFT = Wolf Motor Func- tion Test. * Address all correspondence to Ching-yi Wu, ScD, OTR; Department of Occupational Therapy, Chang Gung Uni- versity, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan; 886-3-2118800, ext 5761; fax: 866-3-2118800, ext 3163. Email: cywu@mail.cgu.edu.tw DOI:10.1682/JRRD.2009.09.0155