Validity, Reliability, and Measurement Error of the Remote Fugl-Meyer Assessment by Videoconferencing: Tele-FMA

Abstract

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.

Repetitive peripheral magnetic stimulation combined with transcranial magnetic stimulation in rehabilitation of upper extremity hemiparesis following stroke: a pilot study

“…First, upper limb improvement is to be expected in the subacute stage of stroke, regardless of the interventions applied. This improvement is important, given that upper-limb motor function improves after a transient initial decline from stroke onset ( 26 ) and such early impairment is associated with long-term disability and impaired quality of life ( 4 ). However, in the current study this area exhibited rapid improvement, as shown by the significant differences observed among the 3 groups.…”

“…Clinical effectiveness was assessed using the FMA-UE score as the primary outcome (score ranged from a minimum of 0 to a maximum of 66) ( 26 ). The Comprehensive Functional Assessment (FCA) and the Barthel Index (BI) were secondary outcomes.…”

“…The Comprehensive Functional Assessment (FCA) and the Barthel Index (BI) were secondary outcomes. Functional assessment of the affected upper extremities was clinically performed at baseline and after completion of therapy at 4 weeks, based on the same scales and using the FMA-UE, which is a highly reliable and sensitive test comprising 33 tasks for the upper extremities ( 26 ). All groups were evaluated at baseline and after treatment or sham treatment.…”

Quantitative Comparison of Hand Kinematics Measured with a Markerless Commercial Head-Mounted Display and a Marker-Based Motion Capture System in Stroke Survivors

“…The research of new clinical tools for the assessment of upper-limb function in post-stroke patients at home is, thus, increasing. Among them, wearable technologies (like Inertial Measurement Units sensors) are under investigation [ 40 , 41 ] and also video-conferencing administration of validated clinical scales [ 42 ], or ad hoc developed tools have been recently proposed [ 43 ]. However, the related literature is still lacking and there is a paucity of technologically and clinically validated solutions for remote kinematic analyses in subjects with neurological disorders.…”

Validity of the telematic Fugl Meyer assessment scale – upper extremity (TFMA-UE) Spanish version

“…Recent studies have investigated the telematics application of this scale. On the one hand, Liz et al ( 48 ) have implemented a study to verify possible errors in the telematic application of the Fugl Meyer scale, concluding that it presents excellent intra- and inter-rater reliability, which makes it valid for the evaluation of these patients. On the other hand, Carmona et al ( 49 ) designed a modified version of the Upper extremity Fugl Meyer Scale with good results, unfortunately these authors did not analyze the psychometric properties of the scale like in our study.…”