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Silva EADM, Batista LR, Braga MAF, Teixeira-Salmela LF, Faria CDCDM, Faria-Fortini I. Predicting self-perceived manual ability at three and six months after stroke: A prospective longitudinal study. J Stroke Cerebrovasc Dis 2024; 33:107479. [PMID: 37984045 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Recovery of manual ability is a critical issue in rehabilitation. Currently, little is known regarding the baseline predictors of self-perceived manual ability, which could capture information on individual's perceived functional ability, especially in carrying-out routine tasks outside clinical settings. OBJECTIVE To identify baseline predictors, which can be easily obtained within clinical settings, of self-perceived manual ability at three and six months after discharge from a stroke unit. METHODS A 6-month longitudinal study was carried-out. Participants were recruited from a stroke unit of a public hospital. The dependent outcome was self-perceived manual ability, and the following predictors were investigated: age, stroke severity, upper-limb motor impairments, cognitive function, muscle strength, and functional capacity. Linear regression analyses were employed to identify multivariate predictors of manual ability at three and six months after discharge (α=5%). RESULTS Participated 131 individuals, 69 women (mean age of 60 years). Regression analyses revealed that stroke severity and age accounted for 31% and 47% of the variance in manual ability at three and six months after stroke, respectively. Stroke severity was the best predictor of manual ability at three (R2=29%; F=44.7; p<0.0001) and six months (R2=45%; F=88.2; p<0.0001) after stroke, respectively. CONCLUSION Stroke severity showed to be the best predictor of manual ability at both three and six months after stroke. Although significant, age added little to the explained variance.
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Affiliation(s)
| | - Ludmilla Ribeiro Batista
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Hochleitner I, Pellicciari L, Castagnoli C, Paperini A, Politi AM, Campagnini S, Pancani S, Basagni B, Gerli F, Carrozza MC, Macchi C, Alt Murphy M, Cecchi F. Intra- and inter-rater reliability of the Italian Fugl-Meyer assessment of upper and lower extremity. Disabil Rehabil 2023; 45:2989-2999. [PMID: 36031950 DOI: 10.1080/09638288.2022.2114553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the intra- and inter-rater reliability motor and sensory functioning, balance, joint range of motion and joint pain subscales of the Italian Fugl-Meyer Assessment (FMA) Upper Extremity (FMA-UE) and Lower Extremity (FMA-LE) at the item- subtotal- and total-level in patients with sub-acute stroke. MATERIALS AND METHODS The FMA was administered to 60 patients with sub-acute stroke (mean age ± SD = 75.4 ± 10.7 years; 58.3% men) and independently rated by two physiotherapists on two consecutive days. Intra- and inter-reliability was studied by a rank-based statistical method for paired ordinal data to detect any systematic or random disagreement. RESULTS The item-level intra- and inter-rater reliability was satisfactory (>70%). Reliability level >70% was achieved at subscale and total score level when one- or two-points difference was considered. Systematic disagreements were reported for five items of the FMA-UE, but not for FMA-LE. CONCLUSIONS The Italian version of the FMA showed to be a reliable instrument that can therefore be recommended for clinical and research purposes.Implications for rehabilitationThe FMA is the gold standard for assessing stroke patients' sensorimotor impairment worldwide.The Italian Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Lower Extremity (FMA-LE) is substantially reliable within and between two raters at the item, subtotal, and total score level in patients with sub-acute stroke.The use of FMA in the Italian context will provide an opportunity for international comparisons and research collaborations.
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Affiliation(s)
| | | | | | | | | | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pontedera, Italy
| | | | | | | | | | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Margit Alt Murphy
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Sardesai S, Solomon JM, Ali AS, Arumugam A, Nazareth ED, Pai AS, Guddattu V, Kumaran D S. Do kinematic measures, added to clinical measures, better predict upper extremity motor impairments at three months post-stroke? J Stroke Cerebrovasc Dis 2023; 32:107245. [PMID: 37453408 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE Predicting post-stroke recovery through prediction models is crucial for choosing appropriate treatment options. However, the existing models predominantly incorporate clinical measures although measurement of movement quality using kinematic measures is essential for distinguishing various types of recovery. Thus, this study aimed at determining if, by considering varied aspects of recovery, adding kinematic measurements over clinical measures would better predict upper extremity (UE) motor impairments at three months post-stroke. MATERIALS AND METHODS Eighty-nine stroke survivors (58.9 ± 11.8 years) were assessed for clinical predictors between 4 and 7 days, kinematic predictors within 1 month, and the impairment outcome of the Fugl Meyer Assessment of the UE (FM-UE) at three months post-stroke. Significant predictors (p<0.05) with a variation inflation factor (VIF) <10 were selected for model development. After performing further step-wise selection, three models incorporating clinical outcomes, kinematic measurements, and a combination of these two, respectively, were formulated. RESULTS The clinical model (R2 = 0.70) included shoulder abduction finger extension (SAFE) scores, the National Institutes of Health Stroke Scale (NIHSS), and the Montreal Cognitive Assessment (MoCA). The kinematic model (R2 = 0.34) included total displacement, total time, and reaction time. The combined model (R2 = 0.72) comprised of SAFE score and shoulder flexion. All the models had a minimal mean squared error on cross validation, which indicated a good validity. CONCLUSION The performance of clinical and combined prediction models for predicting three-month post-stroke UE motor recovery was nearly similar. However, in order to detect minimal changes over time and to understand all aspects of motor recovery, there is a need to add instrument-based kinematic measures.
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Affiliation(s)
- Sanjukta Sardesai
- PhD Scholar, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - John M Solomon
- Additional Professor, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - A Sulfikar Ali
- PhD Scholar, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Ashokan Arumugam
- Associate Professor, Department of Physiotherapy, College of Health Sciences, University of Sharjah, United Arab Emirates
| | - Elton Dylan Nazareth
- PhD Scholar, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal- 576104, Karnataka, India
| | - Aparna S Pai
- Professor, Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104
| | - Vasudeva Guddattu
- Associate Professor, Department of Data Sciences, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104
| | - Senthil Kumaran D
- Additional Professor, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
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Salvalaggio S, Boccuni L, Turolla A. Patient's assessment and prediction of recovery after stroke: a roadmap for clinicians. Arch Physiother 2023; 13:13. [PMID: 37337288 DOI: 10.1186/s40945-023-00167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND AND PURPOSE In neurorehabilitation clinical practice, assessment is usually more oriented to evaluate patient's present status, than to plan interventions according to predicted outcomes. Therefore, we conducted an extensive review of current prognostic models available in the literature for recovery prediction of many functions and constructs, after stroke. We reported results in the form of a practical guide for clinicians, with the aim of promoting the culture of early clinical assessment for patient stratification, according to expected outcome. To define a roadmap for clinicians, a stepwise sequence of five actions has been developed, from collecting information of past medical history to the adoption of validated prediction tools. Furthermore, a clinically-oriented organization of available prediction tools for recovery after stroke have been proposed for motor, language, physiological and independency functions. Finally, biomarkers and online resources with prognostic value have been reviewed, to give the most updated state of the art on prediction tools after stroke. RECOMMENDATIONS FOR CLINICAL PRACTICE Clinical assessment should be directed both towards the objective evaluation of the present health status, and to the prediction of expected recovery. The use of specific outcome measures with predictive value is recommended to help clinicians with the definition of sound therapeutic goals.
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Affiliation(s)
- Silvia Salvalaggio
- Laboratory of Computational Neuroimaging, IRCCS San Camillo Hospital, Venezia, Italy
- Padova Neuroscience Center, Università Degli Studi Di Padova, Via Orus 2/B, 35131, Padova, Italy
| | - Leonardo Boccuni
- Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a La UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de La Salut Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
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García-Rudolph A, Soriano I, Becerra H, Madai VI, Frey D, Opisso E, Tormos JM, Bernabeu M. Predicting models for arm impairment: External validation of the Scandinavian models and identification of new predictors in post-acute stroke settings. NeuroRehabilitation 2023:NRE220233. [PMID: 37248917 DOI: 10.3233/nre-220233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Post-stroke arm impairment at rehabilitation admission as predictor of discharge arm impairment was consistently reported as extremely useful. Several models for acute prediction exist (e.g. the Scandinavian), though lacking external validation and larger time-window admission assessments. OBJECTIVES (1) use the 33 Fugl-Meyer Assessment-Upper Extremity (FMA-UE) individual items to predict total FMA-UE score at discharge of patients with ischemic stroke admitted to rehabilitation within 90 days post-injury, (2) use eight individual items (seven from the Scandinavian study plus the top predictor item from objective 1) to predict mild impairment (FMA-UE≥48) at discharge and (3) adjust the top three models from objective 2 with known confounders. METHODS This was an observational study including 287 patients (from eight settings) admitted to rehabilitation (2009-2020). We applied regression models to candidate predictors, reporting adjusted R2, odds ratios and ROC-AUC using 10-fold cross-validation. RESULTS We achieved good predictive power for the eight item-level models (AUC: 0.70-0.82) and for the three adjusted models (AUC: 0.85-0.88). We identified finger mass flexion as new item-level top predictor (AUC:0.88) and time to admission (OR = 0.9(0.9;1.0)) as only common significant confounder. CONCLUSION Scandinavian item-level predictors are valid in a different context, finger mass flexion outperformed known predictors, days-to-admission predict discharge mild arm impairment.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Ignasi Soriano
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Helard Becerra
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - Vince Istvan Madai
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
- School of Computing and Digital Technology, Faculty of Computing, Engineering and the Built Environment, Birmingham City University, Birmingham, UK
| | - Dietmar Frey
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Josep María Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Montserrat Bernabeu
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
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Prognosis of Individual-Level Mobility and Daily Activities Recovery From Acute Care to Community, Part 2: A Proof-of-Concept Single Group Prospective Cohort Study. Arch Phys Med Rehabil 2022; 104:580-589. [PMID: 36596404 DOI: 10.1016/j.apmr.2022.08.980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To demonstrate a proof-of-concept for prognostic models of post-stroke recovery on activity level outcomes. DESIGN Longitudinal cohort with repeated measures from acute care, inpatient rehabilitation, and post-discharge follow-up to 6 months post-stroke. SETTING Enrollment from a single Midwest USA inpatient rehabilitation facility with community follow-up. PARTICIPANTS One-hundred fifteen persons recovering from stroke admitted to an acute rehabilitation facility (N=115). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Activity Measure for Post-Acute Care Basic Mobility and Daily Activities domains administered as 6 Clicks and patient-reported short forms. RESULTS The final Basic Mobility model defined a group-averaged trajectory rising from a baseline (pseudo-intercept) T score of 35.5 (P<.001) to a plateau (asymptote) T score of 56.4 points (P<.001) at a negative exponential rate of -1.49 (P<.001). Individual baseline scores varied by age, acute care tissue plasminogen activator, and acute care length of stay. Individual plateau scores varied by walking speed, acute care tissue plasminogen activator, and lower extremity Motricity Index scores. The final Daily Activities model defined a group-averaged trajectory rising from a baseline T score of 24.5 (P<.001) to a plateau T score of 41.3 points (P<.001) at a negative exponential rate of -1.75 (P<.001). Individual baseline scores varied by acute care length of stay, and plateau scores varied by self-care, upper extremity Motricity Index, and Berg Balance Scale scores. CONCLUSIONS As a proof-of-concept, individual activity-level recovery can be predicted as patient-level trajectories generated from electronic medical record data, but models require attention to completeness and accuracy of data elements collected on a fully representative patient sample.
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Alt Murphy M, Al-Shallawi A, Sunnerhagen KS, Pandyan A. Early prediction of upper limb functioning after stroke using clinical bedside assessments: a prospective longitudinal study. Sci Rep 2022; 12:22053. [PMID: 36543863 PMCID: PMC9772392 DOI: 10.1038/s41598-022-26585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Early and accurate prediction of recovery is needed to assist treatment planning and inform patient selection in clinical trials. This study aimed to develop a prediction algorithm using a set of simple early clinical bedside measures to predict upper limb capacity at 3-months post-stroke. A secondary analysis of Stroke Arm Longitudinal Study at Gothenburg University (SALGOT) included 94 adults (mean age 68 years) with upper limb impairment admitted to stroke unit). Cluster analysis was used to define the endpoint outcome strata according to the 3-months Action Research Arm Test (ARAT) scores. Modelling was carried out in a training (70%) and testing set (30%) using traditional logistic regression, random forest models. The final algorithm included 3 simple bedside tests performed 3-days post stroke: ability to grasp, to produce any measurable grip strength and abduct/elevate shoulder. An 86-94% model sensitivity, specificity and accuracy was reached for differentiation between poor, limited and good outcome. Additional measurement of grip strength at 4 weeks post-stroke and haemorrhagic stroke explained the underestimated classifications. External validation of the model is recommended. Simple bedside assessments have advantages over more lengthy and complex assessments and could thereby be integrated into routine clinical practice to aid therapy decisions, guide patient selection in clinical trials and used in data registries.
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Affiliation(s)
- Margit Alt Murphy
- grid.8761.80000 0000 9919 9582Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ahmad Al-Shallawi
- grid.510463.50000 0004 7474 9241The Administrative Technical College of Mosul, Northern Technical University, Mosul, Nineveh Iraq
| | - Katharina S. Sunnerhagen
- grid.8761.80000 0000 9919 9582Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anand Pandyan
- grid.17236.310000 0001 0728 4630Faculty of Health and Social Science, Bournemouth University, Bournemouth, UK
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Plantin J, Verneau M, Godbolt AK, Pennati GV, Laurencikas E, Johansson B, Krumlinde-Sundholm L, Baron JC, Borg J, Lindberg PG. Recovery and Prediction of Bimanual Hand Use After Stroke. Neurology 2021; 97:e706-e719. [PMID: 34400568 PMCID: PMC8377875 DOI: 10.1212/wnl.0000000000012366] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 05/20/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke. METHOD In this prospective longitudinal study, 89 patients with first-ever stroke with arm paresis were assessed at 3 weeks and 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), and unimanual motor impairment was assessed with the Fugl-Meyer Assessment (FMA). Candidate predictors included shoulder abduction and finger extension measured by the corresponding FMA items (FMA-SAFE; range 0-4) and sensory and cognitive impairment. MRI was used to measure weighted corticospinal tract lesion load (wCST-LL) and resting-state interhemispheric functional connectivity (FC). RESULTS Initial Ad-AHA performance was poor but improved over time in all (mild-severe) impairment subgroups. Ad-AHA correlated with FMA at each time point (r > 0.88, p < 0.001), and recovery trajectories were similar. In patients with moderate to severe initial FMA, FMA-SAFE score was the strongest predictor of Ad-AHA outcome (R 2 = 0.81) and degree of recovery (R 2 = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome (R 2 = 0.05). Repeated analyses without FMA-SAFE score identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL >5.5 cm3 strongly predicted low to minimal FMA/Ad-AHA recovery (≤10 and 20 points respectively, specificity = 0.91). FC explained some additional variance to FMA-SAFE score only in unimanual recovery. CONCLUSION Although recovery of bimanual activity depends on the extent of corticospinal tract injury and initial sensory and cognitive impairments, FMA-SAFE score captures most of the variance explained by these mechanisms. FMA-SAFE score, a straightforward clinical measure, strongly predicts bimanual recovery. CLINICALTRIALSGOV IDENTIFIER NCT02878304. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that the FMA-SAFE score predicts bimanual recovery after stroke.
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Affiliation(s)
- Jeanette Plantin
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France.
| | - Marion Verneau
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Alison K Godbolt
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Gaia Valentina Pennati
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Evaldas Laurencikas
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Birgitta Johansson
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Lena Krumlinde-Sundholm
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Jean-Claude Baron
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Jörgen Borg
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Påvel G Lindberg
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
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Hernández ED, Forero SM, Galeano CP, Barbosa NE, Sunnerhagen KS, Alt Murphy M. Intra- and interrater reliability of Fugl-Meyer Assessment of Lower Extremity early after stroke. Braz J Phys Ther 2020; 25:709-718. [PMID: 33358073 PMCID: PMC8721065 DOI: 10.1016/j.bjpt.2020.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Fugl-Meyer Assessment of Lower Extremity (FMA-LE) is a widely used and recommended scale for evaluation of post-stroke motor impairment. However, the reliability of the scale has only been established by using parametric statistical methods, which ignores the ordinal properties of the scale. OBJECTIVE To determined intra- and inter-rater reliability of the FMA-LE at item and summed score level early after stroke. METHODS Sixty patients (mean age 65.9 years, median FMA-LE 29 points) admitted to the hospital due to stroke were included. The FMA-LE was simultaneously, but independently, scored by three experienced and trained physical therapists randomly assigned into pairs, on two consecutive days, between 4 to 9 days post stroke. A rank-based statistical method for paired ordinal data was used to assess the level of agreement and systematic and random disagreements. RESULTS The item-level reliability was high (percentage of agreement [PA] ≥75%). Two items (ankle dorsiflexion during flexor synergy and normal reflex activity) showed some systematic disagreement in intrarater analysis. A satisfactory intrarater reliability (PA ≥70%) was reached for all summed scores when a 1- or 2-point difference was accepted between ratings. CONCLUSION The FMA-LE is a reliable tool for assessment of motor impairment both within and between raters early after stroke. The scale can be recommended not only for use in Spanish speaking countries, but also internationally. A unified international use of FMA-LE would allow comparison of stroke recovery outcomes worldwide and thereby potentially improve the quality of stroke rehabilitation.
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Affiliation(s)
- Edgar D Hernández
- Departamento del Movimiento Corporal Humano, Universidad Nacional de Colombia, Bogota, Colombia
| | | | | | | | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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