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Intra- and inter-rater reliability of Fugl-Meyer Assessment of Lower Extremity early after stroke
Brazilian Journal of Physical Therapy ( IF 3.4 ) Pub Date : 2020-12-17 , DOI: 10.1016/j.bjpt.2020.12.002
Edgar D Hernández 1 , Sandra M Forero 2 , Claudia P Galeano 2 , Nubia E Barbosa 2 , Katharina S Sunnerhagen 3 , Margit Alt Murphy 3
Affiliation  

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.



中文翻译:

中风后早期下肢的 Fugl-Meyer 评估的内部和评估者间信度

背景

Fugl-Meyer 下肢评估 (FMA-LE) 是一种广泛使用和推荐的用于评估中风后运动障碍的量表。然而,该量表的信度仅通过使用参数统计方法建立,忽略了量表的序数特性。

客观的

确定 FMA-LE 在项目和中风后早期总分水平上的内部和评估者间可靠性。

方法

包括 60 名因中风入院的患者(平均年龄 65.9 岁,中位 FMA-LE 29 分)。FMA-LE 由三名经验丰富且训练有素的物理治疗师在中风后 4 至 9 天内连续两天随机分配成对进行评分,但同时独立评分。配对序数数据的基于等级的统计方法用于评估一致性水平以及系统性和随机性不一致。

结果

项目级可靠性很高(一致性百分比 [PA] ≥75%)。两个项目(屈肌协同和正常反射活动期间的踝背屈)在评估者内部分析中显示出一些系统性的分歧。当评分之间接受 1 分或 2 分的差异时,所有总分均达到令人满意的评分者内信度 (PA ≥ 70%)。

结论

FMA-LE 是评估中风后早期评估者内部和之间的运动损伤的可靠工具。该量表不仅可以推荐用于西班牙语国家,还可以在国际上使用。FMA-LE 的国际统一使用将允许比较世界范围内的卒中恢复结果,从而有可能提高卒中康复的质量。

更新日期:2020-12-17
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