Translating measurement findings into rehabilitation practice: An example using Fugl-Meyer Assessment-Upper Extremity with patients following stroke

Abstract

Abstract-Standardized assessments are critical for advancing clinical rehabilitation, yet assessment scores often provide little information for rehabilitation treatment planning. A keyform recovery map is an innovative way for a therapist to record patient responses to standardized assessment items. The form enables a therapist to view the specific items that a patient can or cannot perform. This information can assist a therapist in tailoring treatments to a patient's individual ability level. We demonstrate how a keyform recovery map can be used to inform clinical treatment planning for individuals with stroke-related upper-limb motor impairment. A keyform map of poststroke upper-limb recovery defined by items of the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was generated by a previously published Rasch analysis. Three individuals with stroke enrolled in a separate research study were randomly selected from each of the three impairment strata of the FMA-UE. Their performance on each item was displayed on the FMA-UE keyform. The forms directly connected qualitative descriptions of patients' motor ability to assessment measures, thereby suggesting appropriate shorter and longer term rehabilitation goals. This study demonstrates how measurement theory can be used to translate a standardized assessment into a useful, evidence-based tool for making clinical practice decisions.

Trunk Restraint to Promote Upper Extremity Recovery in Stroke Patients

“…Six articles 19,22,27,34,35,36 were excluded because they did not meet the inclusion criteria (Appendix B). Six RCTs 20,21,[23][24][25][26] were 38 There were no reports of dropouts in any of the 6 studies. Methodologies and key findings of the studies are summarized in Table 2.…”

Methods of assessment of movement functions in the upper limb

“…По мнению большинства экспертов, шкала FMA-UE является хорошо продуманным, объективным и эффек-тивным методом клинического обследования больных с инсультом [6][7][8][9][10][11]. Она считается одним из наиболее точ-ных инструментов оценки нарушений двигательных функций после инсульта и используется в качестве объ-ективного показателя их ухудшения и последующего вос-становления [12][13][14][15][16][17].…”

“…Шкала FMA-UE может использоваться для установления цели, плана и мониторинга прогресса лече-ния пациента. Референтные значения составляют от 0 до 20 баллов -тяжелые двигательные нарушения, от 21 до 50 -умеренные и от 51 до 66 -легкие [11].…”

Understanding and supporting occupational therapists clinical decision-making for the management of upper limb post stoke sensory impairment

“…Standardised measurement tools with good psychometric properties provide therapists with information that is the best available and accurate evidence on which to base these decisions (Potter, Fulk, Salem, & Sullivan, 2011). Using standardised measures increases the accuracy of the occupational therapy diagnosis and potentially allows comparison with norms for that behaviour or attribute, improves the targeting of the specific intervention strategies to the functional abilities of the client, as well as assisting with identifying the specific level for the goals being set (Velozo & Woodbury, 2011). Therapists in the survey study identified some of these reasons as reasons why they assess sensory impairments.…”

“…Therapists in the survey study identified some of these reasons as reasons why they assess sensory impairments. The low level of utilisation of standardised measures may be due to difficulties relating the results from these assessments to these key components of intervention planning and CDM (Velozo & Woodbury, 2011). This concern was expressed by therapists in the qualitative study In areas where there is limited or slow development of research evidence, Unsworth (2011) stresses that using standardised outcome measures provides data that therapists can use to evaluate the effectiveness of their specific interventions and also potentially allows sharing of data that could potentially be used in research about these interventions.…”