Fugl-Meyer Assessment-Upper Extremity may be the gold standard in assessing something, but it is completely subjective so completely useless in validating how well interventions work. With no objective starting point you can't make any research on that repeatable.
The 20 tasks in the UEFI include: 20 questions on a 5- point rating scale
- Any of your usual work, housework, or school activities
- Your usual hobbies, recreational or sporting activities All are now impossible; running, biking, canoeing,xc skiing, hunting
- Lifting a bag of groceries to waist level Impossible due to spasticity of the left hand
- Lifting a bag of groceries above your head Impossible due to spasticity of the left arm
- Grooming your hair Well, I'm bald, I can groom my hair with a wet washcloth
- Pushing up on your hands (eg, from bathtub or chair) Impossible due to spasticity of the left arm and hand
- Preparing food (eg, peeling, cutting) Impossible, can't hold anything in left hand
- Driving Now I'm great at this, does require a turn signal extender.
- Vacuuming, sweeping or raking Anything that requires two hands is impossible
- Dressing sitting down to put on underwear, socks, pants, shoes
- Doing up buttons Good fingers only
- Using tools or appliances Nope
- Opening doors Only with good hand
- Cleaning The vacuum has to be battery powered since keeping the cord out of the way doesn't work with affected hand
- Tying or lacing shoes Impossible, no usable finger movement
- Sleeping Difficult because the spastic left arm stays bent, gets in the way on rolling over
- Laundering clothes (eg, washing, ironing, folding) Washing, yes; ironing/folding; impossible
- Opening a jar Impossible, can't get the left hand open enough to grab any jar.
- Throwing a ball Impossible, would have to pry fingers open to get ball inside, then pry then open to release.
- Carrying a small suitcase with your affected limb Impossible
Sensitivity to Change and Responsiveness of the Upper Extremity Fugl-Meyer Assessment in Individuals With Moderate to Severe Acute Stroke
Abstract
Background
The
Fugl-Meyer Assessment-Upper Extremity (FMA-UE) is a widely used outcome
measure for quantifying motor impairment in stroke recovery. Meaningful
change (responsiveness) in the acute to subacute phase of stroke
recovery has not been determined.
Objective
Determine
responsiveness and sensitivity to change of the FMA-UE from 1-week to
6-weeks (subacute) after stroke in individuals with moderate to severe
arm impairment who received standard clinical care.
Methods
A
total of 51 participants with resulting moderate and severe UE
hemiparesis after stroke had FMA-UE assessment at baseline (within 2
weeks of stroke) and 6-weeks later. Sensitivity to change was assessed
using Glass’s delta, standardized response means (SRM), standard error
of measure (SEM), and minimal detectable change (MDC). Responsiveness
was assessed with the minimal clinically important difference (MCID),
estimated using receiver operating characteristic curve analysis with
patient-reported global rating of change scales (GROC) and a
provider-reported modified Rankin Scale (mRS) as anchors.
Results
The
MCID estimates were 13, 12, and 9 anchored to the GROC Arm Weakness,
GROC Recovery, and mRS. Glass’s delta and the SRM revealed large effect
sizes, indicating high sensitivity to change, (∆ = 1.24, 95% CI [0.64,
1.82], SRM = 1.10). Results for the SEM and MDC were 2.46 and 6.82,
respectively.
Conclusion
The
estimated MCID for the FMA-UE for individuals with moderate to severe
motor impairment from 1 to 6-weeks after stroke is 13. These estimates
will provide clinical context for FMA-UE change scores by helping to
identify the change in upper-extremity motor impairment that is both
beyond measurement error and clinically meaningful.
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