Journal of bodywork and movement therapies · 2026
Validation of the Lower Extremity Motor Activity Log (LE-MAL) questionnaire with triaxial accelerometry-based activity monitors in chronic post-stroke hemiparesis.
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Cristina Dos Reis Gabriela, Kelly de Oliveira Nayara, Cerqueira Gomes Dos Santos Laura Hellen, Pereira Natalia Duarte
Аннотация
BACKGROUND: Post-stroke hemiparesis commonly reduces mobility, limiting daily activities and participation. Objective monitoring, such as step counting, quantifies real-world ambulatory activity, while patient-reported outcome measures (PROMs) capture perceived functional performance. The Lower Extremity Motor Activity Log (LE-MAL), translated into Portuguese, assesses self-reported use of the more affected lower limb.
OBJECTIVE: To examine the criterion-related validity of the LE-MAL by evaluating its association with step counts obtained from triaxial accelerometry activity monitors.
METHODS: In this cross-sectional validation study, 31 individuals with chronic post-stroke hemiparesis wore activity monitors for at least 10 h/day over three consecutive days. The LE-MAL was administered via structured interview. Criterion-related validity was assessed using Pearson's correlation coefficient. Agreement was further explored using the intraclass correlation coefficient (ICC; two-way mixed-effects model, consistency) and Bland-Altman analysis.
RESULTS: The LE-MAL total score showed a positive, moderate correlation with the 3-day average step count (r = 0.52, p < 0.01). Agreement between LE-MAL scores and step counts was low (ICC_single = 0.001, 95% CI -0.35 to 0.35; p = 0.497), consistent with conceptual and metric differences between a PROM and an objective activity count. Bland-Altman analysis indicated a mean bias close to zero, wide 95% limits of agreement, and no evidence of proportional bias.
CONCLUSION: The LE-MAL demonstrates a positive, moderate association with objectively measured step counts, supporting its criterion-related validity as a PROM of perceived real-world use of the more affected lower limb. Used alongside activity monitoring, it may help clinicians interpret ambulatory behavior in individuals with chronic post-stroke hemiparesis.
OBJECTIVE: To examine the criterion-related validity of the LE-MAL by evaluating its association with step counts obtained from triaxial accelerometry activity monitors.
METHODS: In this cross-sectional validation study, 31 individuals with chronic post-stroke hemiparesis wore activity monitors for at least 10 h/day over three consecutive days. The LE-MAL was administered via structured interview. Criterion-related validity was assessed using Pearson's correlation coefficient. Agreement was further explored using the intraclass correlation coefficient (ICC; two-way mixed-effects model, consistency) and Bland-Altman analysis.
RESULTS: The LE-MAL total score showed a positive, moderate correlation with the 3-day average step count (r = 0.52, p < 0.01). Agreement between LE-MAL scores and step counts was low (ICC_single = 0.001, 95% CI -0.35 to 0.35; p = 0.497), consistent with conceptual and metric differences between a PROM and an objective activity count. Bland-Altman analysis indicated a mean bias close to zero, wide 95% limits of agreement, and no evidence of proportional bias.
CONCLUSION: The LE-MAL demonstrates a positive, moderate association with objectively measured step counts, supporting its criterion-related validity as a PROM of perceived real-world use of the more affected lower limb. Used alongside activity monitoring, it may help clinicians interpret ambulatory behavior in individuals with chronic post-stroke hemiparesis.