Sensitivity to Change and Responsiveness of the Upper Extremity Fugl-Meyer Assessment in Individuals With Moderate to Severe Acute Stroke.

Autor:	Huynh BP; Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA., DiCarlo JA; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, USA., Vora I; Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA., Ranford J; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA., Gochyyev P; Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA., Lin DJ; Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, USA.; Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.; Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA., Kimberley TJ; Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	Neurorehabilitation and neural repair [Neurorehabil Neural Repair] 2023 Aug; Vol. 37 (8), pp. 545-553. Date of Electronic Publication: 2023 Jul 24.
DOI:	10.1177/15459683231186985
Abstrakt:	Background: The Fugl-Meyer Assessment-Upper Extremity (FMA-UE) is a widely used outcome measure for quantifying motor impairment in stroke recovery. Meaningful change (responsiveness) in the acute to subacute phase of stroke recovery has not been determined. Objective: Determine responsiveness and sensitivity to change of the FMA-UE from 1-week to 6-weeks (subacute) after stroke in individuals with moderate to severe arm impairment who received standard clinical care. Methods: A total of 51 participants with resulting moderate and severe UE hemiparesis after stroke had FMA-UE assessment at baseline (within 2 weeks of stroke) and 6-weeks later. Sensitivity to change was assessed using Glass's delta, standardized response means (SRM), standard error of measure (SEM), and minimal detectable change (MDC). Responsiveness was assessed with the minimal clinically important difference (MCID), estimated using receiver operating characteristic curve analysis with patient-reported global rating of change scales (GROC) and a provider-reported modified Rankin Scale (mRS) as anchors. Results: The MCID estimates were 13, 12, and 9 anchored to the GROC Arm Weakness, GROC Recovery, and mRS. Glass's delta and the SRM revealed large effect sizes, indicating high sensitivity to change, (∆ = 1.24, 95% CI [0.64, 1.82], SRM = 1.10). Results for the SEM and MDC were 2.46 and 6.82, respectively. Conclusion: The estimated MCID for the FMA-UE for individuals with moderate to severe motor impairment from 1 to 6-weeks after stroke is 13. These estimates will provide clinical context for FMA-UE change scores by helping to identify the change in upper-extremity motor impairment that is both beyond measurement error and clinically meaningful.
Databáze:	MEDLINE
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