Hierarchical Properties and Functional Staging of the Fugl-Meyer Assessment Lower Extremity Scale

Abstract

<h3>Research Objectives</h3> This study aimed (1) to investigate the hierarchical properties of FMA-LE and Brunnstrom stages, and (2) to develop a functional staging, a graphical plot, of FMA-LE and its relationships to low (0–21), high (22–34) FMA-LE cut-off scores. <h3>Design</h3> Secondary analysis of cross-sectional data. <h3>Setting</h3> Outpatient rehabilitation settings. <h3>Participants</h3> The Locomotor Experience Applied Post-stroke (LEAPS) trial data included 408 patients with stroke with a mean age of 62 years old (SD = 12.7, range = 25 to 98). The mean onset of stroke was 64 days (SD = 8.5, range = 43 to 112). About 55% of the sample were male. The majority (80%) of the sample had an ischemic stroke. Approximately half of the sample had brain lesions in the right hemisphere, followed by the left hemisphere (35%), brainstem (15%), and bilateral (2%). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> The 17-item FMA-LE assesses lower extremity motor function including reflex activity, movement within and outside synergy patterns, and speed/coordination. It has two subscales: Lower Extremity and Speed/Coordination, which are scored on a 3-level ordinal scale (0 = none; 1 = partial; 2 = full). The total summed score of 34 points indicates normal function. <h3>Results</h3> Overall, the item difficulty hierarchical order of the FMA-LE reflected the Brunnstrom stages. The items from easy to difficult were reflex activity items, followed by items assessing flexor and extensor synergy, and movement with little/no synergies. The ‘normal reflex activity', ‘knee flexion to 90° (hip at 0°)', ‘coordination/speed' items represented the most difficult items. The two-level functional staging was judged to be clinically logical and to provide insight for clinical interpretation of patient progress. We further provided the functional staging for the clinical interpretation across all FMA-LE scores. <h3>Conclusions</h3> Our findings suggest that the FMA-LE items reflect the lower extremity motor recovery stage. This study demonstrates how functional staging can be used to translate a standardized assessment into a useful, evidence-based tool for making clinical practice decisions. <h3>Author(s) Disclosures</h3> The authors declare that there is no conflict of interest.