Motor Activity Log

Last Updated

March 01, 2016

Purpose

The MAL is a semi-structured interview to assess arm function.

Acronym MAL

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

Stroke Recovery

Stroke

Individuals are asked to rate Quality of Movement (QOM) and Amount of Movement (AOM) during 30 daily functional tasks (original MAL), 28 functional tasks (MAL 28), or 14 tasks (MAL 14).
Target tasks include object manipulation (e.g. pen, fork, comb, and cup) as well as the use of the arm during gross motor activities (e.g. transferring to a car, steadying oneself during standing, pulling a chair into a table while sitting).
Items scored on a 6-point ordinal scale.
Scoring on Amount of Use Scale:
0) The weaker arm was not sued at all for that activity (never)
1) Occasionally used weaker arm, but only very rarely (very rarely)
2) Sometimes used weaker arm but did the activity most of the time with stronger arm (rarely)
3) Used weaker arm about half as much as before the stroke (half pre-stroke)
4) Used weaker arm almost as much as before the stroke (3/4 pre-stroke)
5) The ability to use the weaker arm for that activity was as good as before the stroke (normal)
Scoring on Quality of Movement Scale:
0) The weaker arm was not sued at all for that activity (never)
1) The weaker arm was moved during that activity but was not helpful (very poor)
2) The weaker arm was of some use during the activity but needed help from the stronger arm or moved very slowly or with difficutly (poor)
3) The weaker arm was used for the purpose indicated but movements were slow or were made with only some effort (fair)
4) The movements made by the weaker arm were almost normal, but were not quite as fast or accurate as normal (almost normal)
5) The ability to sue the weaker arm for that activity was as good as before the stroke (normal)

Number of Items

30, 28, or 14

Survey Instrument

20 minutes

Required Training

Reading an Article/Manual

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jane Sullivan, PT in 2013. Updated by Maggie Bland PT,DPT,NCS and Nancy Byl PT,MPH,PhD, FAPTA and the StrokEDGE II task force of the Neurology Section of the APTA in 2016.

ICF Domain

Activity
Participation

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:
HR	Highly Recommend
R	Recommend
LS / UR	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations for use based on acuity level of the patient:

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

Recommendations based on level of care in which the assessment is taken:

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
StrokEDGE	No	Yes	Yes	Yes; there are no studies on content or construct validity

Considerations

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Minimal Detectable Change (MDC)

(Simpson, 2015; systematic review of articles for patients post stroke)⁴

MDC₉₀ = 0.56- 1.06

MDC₉₅ = 0.67- 1.27

Minimally Clinically Important Difference (MCID)

Stroke:

(Simpson, 2015)

MCID = 1.0-1.1

Test/Retest Reliability

Stroke:

(Van der Lee JH et al, 2004; n = 56 chronic stroke patients)

Excellent test retest reliability for MAL AOU (r = 0.70 to 0.85)
Excellent test retest reliability for MAL QOM (r = 0.61 to 0.71)

(Uswatte G et al, 2006; n = 41 chronic stroke patients complete MALs before and after CI therapy or a placebo control; n = 27 in second study for chronic stroke patients who complete MALs and wore accelerometers that monitored their arm movements for 3 days outside the laboratory before and after an automated form of CI therapy)

Excellent test retest reliability for MAL 14 QOM (r > 0.91)
Participant AOU and caregiver QOM and AOU scales were not reliable

Internal Consistency

Stroke:

(Van der Lee JH et al, 2004)

Excellent internal consistency for AOU (alpha = 0.88)
Excellent internal consistency for AOU (alpha = 0.91)
Limits of agreement for AOU and QOM (r = -0.70 to 0.85 and 0.61 to 0.71)

(Uswatte G et al, 2006)

Excellent internal consistency of the MAL 14 (alpha > 0.81)

Criterion Validity (Predictive/Concurrent)

Stroke:

(Uswatte G et al, 2005)

Excellent concurrent correlation between QOM (MAL 28) and Stroke Impact Scale Hand Function scores (r = 0.72)
Adequate concurrent correlation between QOM (MAL 28) and accelerometry (r = 0.52) (Van Der Lee JH et al, 2004)
Excellent concurrent correlation between the Action Research Arm Test and MAL 28 (r = 0.63)

(Uswatte G et al, 2005; n = 106 post stroke patients with mild to moderate paresis of upper extremity who took MAL before and after treatment; n = 116 took MAL an equivalent no-treatment period)

Excellent concurrent correlation between the participant QOM scale (MAL 14) and caregiver COM scale (r = 0.70)
Excellent concurrent correlation between the participant QOM scale (MAL 14) and caregiver MAL amount of use (AOU) scale (r = 0.73)
Excellent concurrent correlation between participant QOM scale (MAL 14) and accelerometer recordings (r = 0.91)

(Lin K, et al, 2010; n= 74 chronic stroke patients (17.5±17.7 months post-stroke) who received either distributed constraint induced movement therapy, bilateral arm training, or conventional rehabilitation. This study measured criterion-related validity of the Stroke Impact Scale, SIS and Stroke-Specific Quality of Life Scale, SS-QOL)

Poor to Excellent correlations (0.24-0.68) were seen across each SIS domains. The highest correlations between SIS Hand function (0.58-0.59 for MAL AOU and 0.65-0.68 for MAL QOM).
Poor to Adequate correlations (0.25-0.39) between the MAL-AOU and MAL QOM with the SS-QOL for UE function, self-care, work/productivity, family roles, social roles, and mobility.

(Wu C, et al, 2011; n= 70 chronic stroke patients (19.9±12.5 months post-stroke) received either distributed constraint induced movement therapy, bilateral arm training or control treatment for three weeks)

Poor to Adequate concurrent validity.

	Pre-Intervention (95% CI)	Post-Intervention (95% CI)
	Modified Nottingham Extended Scale	Frenchay Activities Index	Modified Nottingham Extended Scale	Frenchay Activities Index
MAL AOU (30)	0.3 (0.1-0.5)	0.3 (0.1-0.5)	0.3 (0.1-0.5)	0.4 (0.2-0.6)
MAL QOL (3)	0.3 (0.1-0.5)	0.3 (0.1-0.5)	0.2 (0-0.4)	0.3 (0.1-0.5)

Responsiveness

Stroke:

(Van Der Le JH et al, 2004)

In individuals with subacute chronic stroke undergoing constraint induced movement therapy, improvement on the MAL during the intervention was only weakly related to a global change rating and to the improvement on the Action Research Arm Test (Spearman rho = 0.16 to 0.22; responsiveness ration = 1.9 (AOU) and 2.0 (QOM))

(Unswatte G et al, 2005)

For the MAL 14, the responsiveness ration > 3 of the participant QOM scale was supported

(Simpson and Eng 2013)

In this systematic review across 68 studies, the effect size for Patient perception of change (MAL) were 1.6 to 6.2 (mean 1.66) larger than lab-based functional performance measures (ARAT or Wolf)⁴

Effect sizes were larger with greater variance for patients 1-2 months post stroke versus patients > 3 months post stroke

Effect sizes were larger for patients with less severe impairments at 1-2 months post stroke.

Effect sizes calculated based on change score divided by baseline standard deviation (population effect size) were lower than standardized response mean (based on change score divided by the change score standard deviation) for the same measure.

(Hammer and Lindmark, 2010)

Effect Size

Effect Size: .51 MAL-AOU and .54 MAL-QOM during intervention and 1.02 MAL-AOU and 1.17 MAL-QOM pre intervention to 3 mo F/U⁵

SRM: 1.28 MAL-AOU and 1.03 MAL QOM during intervention and 1.14 MAL-AOU and 1.19 MAL-QOM 3 mo after treatment

Responsiveness Ratios

RR: 1.22 MAL-AOU and 1.23 MAL-QOM during intervention and 2.44 MAL-AOU and 2.69 MAL-QOM 3 month after treatment

Bibliography

Hammer AM, Lindmark B. Responsiveness and vaidity of the Motor Activity og in patients during the subacute phase after stroke Disability and Rehabilitation 2010; 32 (14):1184-1193 Find it on PubMed

Lin K-c, Chuang L-l, Wu C-y, Hsieh Y-w. Responsiveness and validity of three dexterous function measures in stroke rehabilitation. J of Rehabilitation Research and Development: 2010;47 (4): 563-572 Find it on PubMed

Lin K-C, Fu T Wu C-Y, Hsieh Y-W, Chen C-L, Lee P-C. Psychometric comparisons of the Stroke Impact Scale 3.0 and Stroke-Specific Quality of Liv Scale. Research 2010; 29 (3):435-443 Find it on PubMed

Simpson LA, Eng JJ Functional recovery following stroke: Capturing changes in upper extremity function Neurorehabil Neural Repair 2013: 240-250. Find it on PubMed

Uswatte, G., Taub, E., et al. (2006). "The Motor Activity Log-28 Assessing daily use of the hemiparetic arm after stroke." Neurology 67(7): 1189-1194. Find it on PubMed

Uswatte, G., Taub, E., et al. (2005). "Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use." Stroke 36(11): 2493-2496. Find it on PubMed

Van der Lee, J., Beckerman, H., et al. (2004). "Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients." Stroke 35(6): 1410-1414. Find it on PubMed

Wu C-y,Chuang L-l Lin K-c, Horng Y-s. Responsiveness and validity of two outcome measures of instrumental activities of daily living in stroke survivors receiving rehabilitative therapies.Clinical Rehabilitation 2011; 26:176-183 Find it on PubMed

Last Updated

Purpose

Assessment Type

Administration Mode

Cost

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

ICF Domain

Professional Association Recommendation

Considerations

Minimal Detectable Change (MDC)

Minimally Clinically Important Difference (MCID)

Test/Retest Reliability

Internal Consistency

Criterion Validity (Predictive/Concurrent)

Responsiveness

Bibliography

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