Using Fugl-Meyer for anything in stroke is the height of stupidity, nothing objective in it, so nothing is repeatable.
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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