Hierarchical Properties of the Fugl-Meyer Assessment Upper Extremity Scale for People After Stroke

Research Objectives: This study aimed (1) to investigate the hierarchical properties of FMA-UE and Brunnstrom stages, and (2) to develop a functional staging, a graphical plot, of FMA-UE and its relationships to severe (0–28), moderate (29–42), and mild (43–66) FMA-UE cut-off scores.

Design: Secondary analysis of cross-sectional data.

Setting: Outpatient rehabilitation settings.

Participants: The Locomotor Experience Applied Post-stroke (LEAPS) trial data included 408 patients with stroke with a mean age of 62 years old (SD = 12.7, range = 25 to 98). The mean onset of stroke was 64 days (SD = 8.5, range = 43 to 112). About 55% of the sample were male. The majority (80%) of the sample had an ischemic stroke. Approximately half of the sample had brain lesions in the right hemisphere, followed by the left hemisphere (35%), brainstem (15%), and bilateral (2%). Although most of the sample was White (58%), other racial groups were represented: Black (22%), Asian (13%), Native Hawaiian or other Pacific Islander (5%), and American Indian/Alaska Native (1%).

Interventions: N/A.

Main Outcome Measures: The 33-item FMA-UE has four subsections: (1) shoulder-arm, (2) wrist, (3) hand, and (4) coordination and speed designed to measure impairment from proximal to distal, reflexive to voluntary, and synergistic to isolated voluntary movement.

Results: Overall, the item difficulty hierarchical order of the FMA-UE reflected the Brunnstrom stages. The items from easy to difficult were reflex activity items, followed by items assessing flexor and extensor synergy, movement combining synergies, and movement out of synergy. The ‘normal reflex activity’, ‘shoulder flexion 90-180°’, ‘coordination/speed’ items represented the most difficult items. The three-level functional staging was judged to be clinically logical and to provide insight for clinical interpretation of patient progress.

Conclusions: Our findings suggest that the FMA-UE items reflect the upper extremity motor recovery stage. This study demonstrates how functional staging can be used to translate a standardized assessment into a useful, evidence-based tool for making clinical practice decisions.

Author(s) Disclosures: The authors declare that there is no conflict of interest.