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.

A Sensor-Based Upper Limb Treatment in Hemiplegic Patients: Results from a Randomized Pilot Study

“…The improvement was higher than the minimal clinically important difference of 9 points suggested by Arya et al [ 38 ] in subacute stroke patients, suggesting clinically important changes in FMA-UE motor skills compared to baseline in these patients over time. Again, the current findings are consistent with the study by Huynh et al [ 39 ], who recently reported that the responsiveness of “a 13-point change on the FMA-UE during the acute to subacute phase of stroke recovery (acute to 6 weeks post stroke) reflects a meaningful change in the recovery of arm motor impairment”.…”

Concurrent Validity and Responsiveness of Clinical Upper Limb Outcome Measures and Sensor-based Arm Use Metrics within the First Year after Stroke: A Longitudinal Cohort Study

“…For instance, an MIC of ≥4 points for the FMA-UE was reported concerning a 3-week conventional rehabilitation in patients with mild-to-moderate impairment 117 . In contrast, considerably higher MICs were reported in severely impaired patients exhibiting larger change rates during four weeks of repetitive task training (≥9 points) 44 and during eight weeks of conventional rehabilitation (MIC ≥13 points) 105 . Hence, the MICs presented in this study should be interpreted based on the period's baseline conditions and duration, respectively.…”

“…Still, they remained at moderate levels in later periods and within the rst days poststroke. A linear relationship between the GRPC scores, the FMA-UE 105 , and the ARAT 43 was previously only reported for the rst few weeks following stroke. Therefore, our ndings, including longitudinal correlations of multiple outcome measures, crucially contribute to this body of evidence.…”