Hierarchical Properties of the Motor Function Sections of the Fugl-Meyer Assessment Scale for People After Stroke: A Retrospective Study

Abstract

The upper-extremity (UE) and lower-extremity (LE) sections (excluding balance) of the motor function domain of the Fugl-Meyer (FM) assessment scale (a construct referred to here as the FM motor scale) are recognized as a robust part of the scale for use with people after stroke. However, it is frequently criticized as a lengthy and time-consuming measurement tool. The aims of this study were to support a shortened method of administration for the FM motor scale and to provide arguments for the use of a summed score. In pursuit of these aims, the hierarchical properties of both the UE and LE sections of the FM motor scale were investigated. A retrospective analysis of data from 62 people with a previous stroke was performed. Guttman scale analysis considered the hierarchy of items within each subsection and each stage, between subsections and stages, and across all of the scale items (ignoring the stage divisions) of the FM motor scale. For the within-stage and subsection analyses and between-stage and subsection analyses, all of the results met or exceeded the acceptable levels for the coefficient of reproducibility and the coefficient of scalability. When stage divisions were ignored, the coefficient of reproducibility for both extremities was just below acceptable levels. The results support the use of the UE and LE sections of the FM motor scale as a stagewise and subsectionwise hierarchical assessment and outcome measure. This allows the use of a shortened method of administration, which can potentially reduce the time required for scale administration, and appropriate scores can be allocated for untested items, such that a legitimate total summed score can be used. A limitation of this study was that the study population consisted predominantly of older people with such severe disability that they were unable to function independently.