A Revised Motor Activity Log Following Rasch Validation (Rasch-Based MAL-18) and Consensus Methods in Chronic Stroke and Multiple Sclerosis

Ann L Van de Winckel, Lynne Gauthier

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives. To derive a shorter version of the Motor Activity Log Quality-of-Movement Scale (MAL-28) with enhanced content and construct validity. Design. Validation cohort. Setting. Outpatient rehabilitation within an academic laboratory. Participants. Retrospective consecutive sample of 149 community-dwelling adults with chronic mild/moderate upper-extremity hemiparesis caused by stroke or multiple sclerosis (MS). Intervention. Not applicable. Methods. Participants received the MAL-28 at baseline and following upper-extremity rehabilitation. Rasch Measurement Theory informed threshold ordering of scoring categories, tests of fit, differential item functioning, targeting, response dependency, local dependency, and reliability (person separation index [PSI]). Seasoned examiners rated the content validity of each item. Test-retest reliability of the revised scale was calculated. Results. We established content and construct validity for 18 items. The resultant 18-item MAL fit the model (χ2 = 77.93; df = 72; P =.30) and targeted the population—that is, minimal floor (12.08%) or ceiling effects (0%), with acceptable reliability (PSI = 0.84) and good test-retest reliability [ICC(1, 1) = 0.86]. The hierarchy of item difficulty was independent of sex, age, affected side, diagnosis, or intervention type used, and there was local dependency in 3 pairs of items. Responses from a subsequent testing session were dependent on the responses from prior testing, indicating response dependency, for which a correction was proposed. Once response dependency was neutralized, there was a 15% greater treatment response. Conclusions. Content and construct validity are established for Rasch-based MAL-18 for chronic stages of stroke and MS. A Rasch-based conversion table enables clinical use of the MAL-18.

Original languageEnglish (US)
Pages (from-to)787-791
Number of pages5
JournalNeurorehabilitation and Neural Repair
Issue number10
Early online dateAug 18 2019
StatePublished - Oct 1 2019

Bibliographical note

Funding Information:
The authors acknowledge Kristina Kelly, PT, Alexandra Borstad, PT, PhD, Kala Phillips, Alli Hall, Mary Russell, Troy Richter, and other members of the Neurorecovery and Brain Imaging laboratory for their contribution toward data collection. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this research was provided by the American Heart Association (AHA), National MS Society, Rudi Schulte Foundation, and the Patient-Centered Outcomes Research Institute (PCORI). The statements in this publication are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies. Additional support for participant recruitment and regulatory affairs was provided by the Center for Clinical and Translational Sciences (National Center for Advancing Translational Sciences, Grant No. 8UL1TR000090-05). Access to the original dataset: https://drive.google.com/file/d/1-f60lqIxKIRKPUekgcmT5ckfjjGbPt7B/view?usp=sharing.

Publisher Copyright:
© The Author(s) 2019.


  • Motor Activity Log
  • multiple sclerosis
  • Rasch
  • stroke
  • upper extremity
  • validity

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural


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