How Do Fugl-Meyer Arm Motor Scores Relate to Dexterity According to the Action Research Arm Test at 6 Months Poststroke?

Abstract

ObjectiveTo determine the optimal cutoff scores for the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) with regard to predicting no, poor, limited, notable, or full upper-limb capacity according to frequently used cutoff points for the Action Research Arm Test (ARAT) at 6 months poststroke. DesignProspective. SettingRehabilitation center. ParticipantsPatients (N=460) with a first-ever ischemic stroke at 6 months poststroke. InterventionsNot applicable. Main Outcome MeasuresBased on the ARAT classification of poor to full upper-limb capacity, receiver operating characteristic curves were used to calculate the area under the curve, optimal cutoff points for the FMA-UE were determined, and a weighted kappa was used to assess the agreement. ResultsFMA-UE scores of 0 through 22 represent no upper-limb capacity (ARAT 0–10); scores of 23 through 31 represent poor capacity (ARAT 11–21); scores of 32 through 47 represent limited capacity (ARAT 22–42); scores of 48 through 52 represent notable capacity (ARAT 43–54); and scores of 53 through 66 represent full upper-limb capacity (ARAT 55–57). Overall, areas under the curve ranged from .916 (95% confidence interval [CI], .890–.943) to .988 (95% CI, .978–.998; P<.001). ConclusionsThere is considerable overlap in the area under the curve between the ARAT and FMA-UE. FMA-UE scores >31 points correspond to no to poor arm-hand capacity (ie, ≤21 points) on the ARAT, whereas FMA-UE scores >31 correspond to limited to full arm-hand capacity (ie, ≥22 points) on the ARAT.