Abstract
Background The motor function section of the Fugl-Meyer assessment scale (FM motor scale) is a robust scale of motor ability in people after stroke, with high predictive validity for outcome. However, the FM motor scale is time-consuming. The hierarchical properties of the upper extremity (UE) and lower extremity (LE) sections of the FM motor scale have been established in people with chronic stroke. These data support the use of a more concise method of administration and confirm scores can be legitimately summed.
Objective The aim of this study was to establish that a similar hierarchy exists in people within 72 hours after stroke onset.
Design A prospective, cross-sectional design was used.
Methods Data were obtained from 75 eligible people in a nationwide prospective study (the Early Prediction of Functional Outcome After Stroke). The full version of both sections of the FM motor scale was administered within 72 hours after stroke onset. The hierarchy of item difficulty was investigated by applying Guttman scaling procedures within each stage and each subsection of the UE and LE sections of the scale. The scaling procedures then were applied to item difficulty between stages and subsections and finally across all scale items (stage divisions ignored) of the FM motor scale.
Results For all analyses, the results exceeded acceptable levels for the coefficient of reproducibility and the coefficient of scalability.
Limitations The sample was a population of people with stroke of moderate severity.
Conclusions The unidimensional hierarchy of the UE and LE sections of the FM motor scale (already established for chronic stroke) within 72 hours after stroke onset was confirmed. A legitimate total summed score can indicate a person's level of motor ability.
Footnotes
Ms Crow and Ms Harmeling-van der Wel provided concept/idea/research design. Ms Crow, Professor Kwakkel, Dr Bussmann, and Ms Harmeling-van der Wel provided writing. Mr Goos and Ms Harmeling-van der Wel provided data collection. Ms Crow provided data analysis. Ms Harmeling-van der Wel provided project management, institutional liaisons, and clerical support. Professor Kwakkel, Dr Bussmann, and Ms Harmeling-van der Wel provided consultation (including review of manuscript before submission).
The authors acknowledge the EPOS Investigators: Executive committee: Professor Gert Kwakkel, PhD, principal investigator, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands, and Department of Neurorehabilitation, Reade Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands; and Barbara C. Harmeling-van der Wel, co-principal investigator, Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands. Steering committee and data management: Janne M. Veerbeek, MSc, and Rinske H.M. Nijland, MSc, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands. Monitoring board: Marijke A. van der Beek, UMC Utrecht; Utrecht, the Netherlands; Wam A.M. Cornelissen, AMC Amsterdam, Amsterdam, the Netherlands; Jos A.G. Goos, MNR, Franciscus Hospital, Roosendaal, the Netherlands; Claudia Steeg, UMC Sint Radboud, Nijmegen, the Netherlands; Richard Tichelaar, Amphia Hospital, Breda, the Netherlands; and Joke M. Timmermans, Leiden University Medical Center, Leiden, the Netherlands.
Ethics approval for the EPOS Study was granted by the Medical Ethics Testing Committee, VU University Medical Center, Amsterdam, the Netherlands.
Part of this study was presented as a poster at the World Confederation for Physical Therapy Congress; June 20–22, 2011; Amsterdam, the Netherlands.
Data collection was funded by Wetenschappelijk College Fysiotherapie (WCF no. 33368) of the Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, the Netherlands.
- Received May 7, 2013.
- Accepted March 13, 2014.
- © 2014 American Physical Therapy Association
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