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Inter-Rater Differences in Post-Stroke Rehabilitation Assessments: Towards Optimising Stroke Recovery
Mohd Azri Bin Abd Mutalib
Stroke assessment is a crucial process for evaluating post-stroke patients' functional abilities,
offering essential insights into recovery progress, residual impairments, and the capacity to perform
daily activities. These assessments are designed to identify specific deficits in motor function,
coordination, and strength, facilitating the development of tailored rehabilitation plans. However,
the reliance on manual methods and subjective judgments often leads to inconsistencies, as
evaluations heavily depend on individual therapists' perceptions. This subjectivity introduces
variability, where the same patient's performance may be interpreted differently by different
therapists, resulting in inconsistent outcomes. Inter-rater variability further compounds the issue,
with differences in scoring methods and interpretations among therapists. This study is conducted
to determine the impact of these variations on stroke rehabilitation assessments. A total of 56 stroke
subjects are assessed by three therapists with varying levels of experience from Sultan Ahmad Shah
Medical Centre (SASMEC), Kuantan, Pahang. The assessment focuses on the patients' ability to
perform 10 Activities of Daily Living (ADLs) derived from the Motor Activity Log (MAL), an
established standard clinical assessment protocol. Statistical analysis using ANOVA indicates that
the p-values for the Amount of Use (AOU) and Quality of Movement (QOM) scales are 0.189 and
0.515, respectively, demonstrating no statistically significant differences among the therapists'
ratings despite observed variations. These findings suggest that the differences among therapists are
not substantial to undermine the reliability of the assessment process. To enhance consistency and
reduce individual biases, averaging the scores from multiple therapists is recommended as an
effective approach for obtaining a more robust and standardised representation of a patient's
functional abilities.
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