Finding a clinical assessment scale - Physical Medicine and Rehabilitation

Description:

The Fugl-Meyer scale was developed as the first quantitative evaluation instrument to measure post-CVA motor and sensory recovery. It is based on the concept of the Twitchell and Brunnstrom recovery (series of well identified stereotypical stages).

The FMA includes five sections: • Motor function (including an assessment of the upper and lower extremities), • Balance, • Sensory function, • Joint range of motion, • Joint pain.

A three-point ordinal scale (0: cannot perform; 1: performs partially; 2: performs fully) is applied to each item.

The maximum score is 226.

The scores for each of the sections can be used as independent sub-scales [4] (but they have not all demonstrated their validity). The total motor function score is out of 100 (divided into 66 points for the upper limb and 34 for lower limb), the sensory function score out of 24 points, balance (sitting and standing) out of 14 points, and the joint range of motion out of 44, as is pain.

The test lasts around 30 minutes.

There is no material cost, but it requires a trained administrator.

There is no material cost, but it requires a trained administrator.

> Access to the scale is free.

Psychometric properties:

General comment on reliability:

This scale, and its sub-groups, has been widely studied in the press.
With regard to the validity:
1) Strong correlations between the initial upper limb + lower limb motor function score and the final upper limb + lower limb score, and with the final FIM (Functional Independence Measure) [14, 26], and between the total FMA and the two components of the ARAT (Functional Ability and Quality of Movement) [18, 20, 21]. However, the concomitant validity between the FMA motor function upper limb (wrist and hands) and the ARAT is moderate [32].
2) Good concomitant validity with the STREAM and the short versions of the STREAM and the FMA, but less good predictive validity [24].
3) High correlations with the Functional Test for the Hemiplegic/Paretic Upper Extremity [5].
4) Good validity between the FMA motor function and Gait speed and Gait comfort, but poor correlations between the FMA sensory and Gait speed and Gait comfort [12].
5) The sub-scale of the FMA evaluating balance has a poor validity in evaluating balance [11].
With regard to accuracy:
1) High inter- [2, 3, 8, 17, 20, 27] and intra-rater reproducibility [2].
2) Very good accuracy for the subgroups upper limb and lower limb motor function [28, 29] and joint range of motion [28], average for the sensory function sub-group [28], sometimes high depending on the studies [29], and low for the pain component [28].
3) Test retest high [24].
With regard to internal consistency:
1) Excellent correlations between the upper limb and lower limb subsections with the total FMA [4].
2) It has been proposed to delete the reflex assessment, which would give a modified FMA motor function in upper limbs with 30 items (which demonstrates a unidimensional structure) [22].
3) High level of internal consistency for the FMA motor function upper limb wrist and hands [32].
With regard to the sensitivity to change:
1) This varies according to the studies:
- The ARAT is more sensitive to change than the FMA in assessing the upper limb function in patients in chronic phase post-CVA [15].
- The sensitivity to change of the FMA motor function upper limb is better than that of the ARAT [26] but remains moderate [27],
- Good sensitivity to change for the motor component in the upper limb [21, 30].
- Sensitivity to change quite poor for the FMA and the STREAM [24].
2) Good sensitivity to change for the FMA Balance in the first 90 days, but low subsequently [17].
Other comments:
1) The combination of the motor and sensory scores 5 days post-CVA predict 75% of the variance in the final motor function of the patients after 6 months. [7].
2) Significant ceiling and floor effects [17].
3) The MDC (Minimal Detection Change, which is a statistical estimate of the smallest quantity of change that can be detected by a measurement and which corresponds to a notable change) is satisfactory for the FMA and ARAT, hence a usefulness of these 2 tests in a clinical context in comparison to the WMFT [27].
4) The PASS (Postural Assessment Scale for Stroke Patients) demonstrates a slight superiority concerning the psychometric characteristics over the FMA Balance and the Berg Balance Scale. [17].
5) The FMA or the MSS (Motor Status scale) would be the best choice to evaluate the functional improvement in robotic training studies of the upper limbs post-CVA, with a high sensitivity to change and a good correlation with the ARAT [30].
6) Compared to the ARAT and the WMFT, the FMA is a relatively good criterion for evaluation of motor function post-CVA [26].
7) It can specifically detect changes in motor function in patients after the rehabilitation period [26].
8) The FMA makes it possible to distinguish the degree of motor function better than the MAS (Motor Assessment Scale) at the start of recovery or in the most disabled subjects [11].
9) The psychometric properties of the FMA-sensory function do not make it possible in clinical practice to measure sensory function post-CVA [19].
10) The FMA motor function upper limb wrist and hands is not yet a validated scale for evaluating distal movement of the upper limbs post-CVA with mild motor deficit [32].

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