Ann Rehabil Med.  2021 Apr;45(2):83-98. 10.5535/arm.20225.

The Korean Version of the Fugl-Meyer Assessment: Reliability and Validity Evaluation

• Kim Tl
• Hwang SH
• Lee WJ
• Hwang JW
• Cho I
• Kim EH
• Lee JA
• Choi Y
• Park JH
• Shin JH

• KMID: 2515389
• DOI: http://doi.org/10.5535/arm.20225

Abstract

Objective
To systematically translate the Fugl-Meyer Assessment (FMA) into a Korean version of the FMA (K-FMA).
Methods
We translated the original FMA into the Korean version with three translators and a translation committee, which included physiatrists, physical therapists, and occupational therapists. Based on a test-retest method, each of 31 patients with stroke was assessed by two evaluators twice, once on recruitment, and again after a week. Analysis of intra- and inter-rater reliabilities was performed using the intra-class correlation coefficient, whereas validity was analysed using Pearson correlation test along with the Motricity Index (MI), Motor Assessment Scale (MAS), and Berg Balance Scale (BBS).
Results
The intra- and inter-rater reliabilities were significant for the total score, and good to excellent reliability was noted in all domains except for the joint range of motion of the lower extremity domain of the K-FMA. The MI and MAS scores were significantly correlated with all domains, all with p<0.01. The results for the MI ranged from r=0.639 to r=0.891 and those for the MAS from r=0.339 to r=0.555. However, the BBS was not significantly correlated with any domain, as the K-FMA lacks balance evaluation items.
Conclusion
The K-FMA was found to have high reliability and validity. Additionally, the newly developed manual for the K-FMA may help minimise errors that can occur during evaluation and improve the reliability of motor function evaluation.

Keyword

Restroke rehabilitation; Fugl-Meyer Assessment; Translation; Reliability; Validity

Reference

1. Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009; 8:741–54.

2. Shavelle RM, Brooks JC, Strauss DJ, Turner-Stokes L. Life expectancy after stroke based on age, sex, and Rankin grade of disability: a synthesis. J Stroke Cerebrovasc Dis. 2019; 28:104450.

3. Jehkonen M, Ahonen JP, Dastidar P, Koivisto AM, Laippala P, Vilkki J, et al. Predictors of discharge to home during the first year after right hemisphere stroke. Acta Neurol Scand. 2001; 104:136–41.

4. Barbosa NE, Forero SM, Galeano CP, Hernandez ED, Landinez NS, Sunnerhagen KS, et al. Translation and cultural validation of clinical observational scales: the Fugl-Meyer assessment for post stroke sensorimotor function in Colombian Spanish. Disabil Rehabil. 2019; 41:2317–23.

5. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med. 1975; 7:13–31.

6. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002; 16:232–40.

7. Michaelsen SM, Rocha AS, Knabben RJ, Rodrigues LP, Fernandes CG. Translation, adaptation and inter-rater reliability of the administration manual for the FuglMeyer assessment. Rev Bras Fisioter. 2011; 15:80–8.

8. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983; 63:1606–10.

9. Sanford J, Moreland J, Swanson LR, Stratford PW, Gowland C. Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Phys Ther. 1993; 73:447–54.

10. Sullivan KJ, Tilson JK, Cen SY, Rose DK, Hershberg J, Correa A, et al. Fugl-Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials. Stroke. 2011; 42:427–32.

11. See J, Dodakian L, Chou C, Chan V, McKenzie A, Reinkensmeyer DJ, et al. A standardized approach to the Fugl-Meyer assessment and its implications for clinical trials. Neurorehabil Neural Repair. 2013; 27:732–41.

12. Malouin F, Pichard L, Bonneau C, Durand A, Corriveau D. Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer assessment and the Motor Assessment Scale. Arch Phys Med Rehabil. 1994; 75:1206–12.

13. Nadeau S, Arsenault AB, Gravel D, Bourbonnais D. Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke. Am J Phys Med Rehabil. 1999; 78:123–30.

14. Shelton FD, Volpe BT, Reding M. Motor impairment as a predictor of functional recovery and guide to rehabilitation treatment after stroke. Neurorehabil Neural Repair. 2001; 15:229–37.

15. Mao HF, Hsueh IP, Tang PF, Sheu CF, Hsieh CL. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke. 2002; 33:1022–7.

16. Hsieh YW, Wu CY, Lin KC, Chang YF, Chen CL, Liu JS. Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation. Stroke. 2009; 40:1386–91.

17. Dettmann MA, Linder MT, Sepic SB. Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. Am J Phys Med. 1987; 66:77–90.

18. Deakin A, Hill H, Pomeroy VM. Rough guide to the Fugl-Meyer Assessment: upper limb section. Physiotherapy. 2003; 89:751–63.

19. Amano S, Umeji A, Uchita A, Hashimoto Y, Takebayashi T, Kanata Y, et al. Reliability and validity of arm function assessment for the Fugl–Meyer assessment with a Japanese guideline. Ann Phys Rehabil Med. 2018; 61 Suppl:e186.

20. Lundquist CB, Maribo T. The Fugl-Meyer assessment of the upper extremity: reliability, responsiveness and validity of the Danish version. Disabil Rehabil. 2017; 39:934–9.

21. Park M, Lee JY, Ham Y, Oh SW, Shin JH. Korean version of the Stroke Rehabilitation Motivation Scale: reliability and validity evaluation. Ann Rehabil Med. 2020; 44:11–9.

22. Fayazi M, Dehkordi SN, Dadgoo M, Salehi M. Test-retest reliability of Motricity Index strength assessments for lower extremity in post stroke hemiparesis. Med J Islam Repub Iran. 2012; 26:27–30.

23. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008; 88:559–66.

24. Stevenson TJ. Detecting change in patients with stroke using the Berg Balance Scale. Aust J Physiother. 2001; 47:29–38.

25. Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess. 1994; 6:284–90.

26. Hinkle DE, Wiersma W, Jurs SG. Applied statistics for the behavioral sciences. Boston, MA: Houghton Mifflin;2003.

27. Hsueh IP, Wang CH, Sheu CF, Hsieh CL. Comparison of psychometric properties of three mobility measures for patients with stroke. Stroke. 2003; 34:1741–5.

28. de Oliveira R, Cacho EW, Borges G. Post-stroke motor and functional evaluations: a clinical correlation using Fugl-Meyer assessment scale, Berg balance scale and Barthel index. Arq Neuropsiquiatr. 2006; 64:731–5.

29. Kim H, Her J, Ko J, Park DS, Woo JH, You Y, et al. Reliability, concurrent validity, and responsiveness of the Fugl-Meyer Assessment (FMA) for hemiplegic patients. J Phys Ther Sci. 2012; 24:893–99.

30. Bae WS, Lee GC, Nam HC. The relation between the Fugl-Meyer motor assessment and walking and balance ability in stroke patient. J Korean Soc Phys Med. 2011; 6:59–69.