Objective
The objective of this study was to investigate the validity, reliability, and measurement error of the Fugl-Meyer Assessment (FMA) when it was administered remotely by videoconferencing (Tele-FMA) and to describe barriers to remote administration of the FMA.
Method
Forty-five participants who had strokes and had a smartphone or laptop computer with a camera and internet access were included. An in-person assessment was compared to a remote assessment in 11 participants, and 34 participants completed only the remote assessment. Rater 1 remotely administered, recorded, and scored the items of the FMA, after which the recording was forwarded to be scored by Rater 2. At least 7 days later, rater 1 rated the videorecording of the remote assessment a second time for the evaluation of intrarater reliability. In-person assessment was completed by rater 1 at the participant’s home. Criterion validity was analyzed using the Bland–Altman limits of agreement, and convergent validity was analyzed using Spearman correlation coefficient. The intrarater and interrater reliability was analyzed using the intraclass correlation coefficient, and individual items were analyzed using the weighted kappa. The standard error of measurement (SEM) and minimal detectable change (MDC) were calculated to evaluate the measurement error.
Results
Bland–Altman plots showed adequate agreement of in-person FMA and tele-FMA. A moderate positive correlation was found between Tele-FMA lower extremity (LE) scores and step test results, and a strong positive correlation was found between Tele-FMA-upper extremity (UE) and Stroke Impact Scale hand function domain. Significant and excellent (0.96 ≤ ICC ≤ 0.99) interrater and intrarater reliabilities of the Tele-FMA, Tele-FMA-UE, and tele-FMA-LE were found. Regarding the individual items, most showed excellent reliability (weighted kappa >0.70). The SEM for both reliabilities was small (≤3.1 points). The MDC95 for both the Tele-FMA and Tele-FMA-UE was 2.5 points, whereas it was 1.3 points for the Tele-FMA-LE.
Conclusion
Tele-FMA has excellent intrarater and interrater reliability and should be considered as a valid measurement.
Impact
The FMA is widely used in clinical practice. However, the measurement properties of the remote version applied by videoconferencing were unknown. This study's results demonstrate the validity and reliability of the Tele-FMA for assessing poststroke motor impairment remotely via videoconferencing. The Tele-FMA may be used to implement telerehabilitation in clinical practice.
surface was fit (least squares) to the AC surface data points; 2. The bicubic surface was subtracted from the AC surface, resulting in a surface that was assessed by a standard roughness analysis method, R q (Root Mean Square surface height; See ISO 25178). Finally the OARSI grading reference was obtained from Safranin-O stained sections. Results: The developed algorithm successfully segmented the AC surface of the mCT volumes (Fig 2). In mCT, the surface of sample 1 appears to be smooth with minor roughness (Fig 2a, black arrows), barely visible in histology. In addition to roughness, fissures (Samples 2-5; Fig 2b-e, yellow arrows; OARSI grade 3.5-4.5), erosion (Samples 3-5; Fig 2c-d, blue arrows; OARSI grade 4-4.5) and mid-zone excavation (Sample 5;
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.