Intra- and inter-rater reliability of Fugl-Meyer Assessment of Upper Extremity in stroke

Abstract

Objective: The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) is recommended for evaluation of sensorimotor impairment post stroke, but the item-level reliability of the scale is unknown. The study aims to determine intra- and inter-rater reliability of the FMA-UE at item-, subscale- and total score level in patients with early subacute stroke. Design: Intra/inter-rater reliability. Subjects: Sixty consecutively included patients with stroke (mean age 65.9 years) admitted to Central Military Hospital of Colombia, Bogota. Methods: Two physiotherapists scored FMA-UE independently on 2 consecutive days within 10 days post stroke. A rank-based statistical method for paired ordinal data was used to assess the level of agreement, systematic and random disagreements. Results: Systematic disagreements either in position or concentration were detected in 4 items of the shoulder section. The item level intra- and inter-rater agreement was high (79–100%). The 70% agreement was also reached for the subscales and the total score when 1–3-point difference was accepted. Conclusion: The FMA-UE is reliable both within and between raters in patients with stroke in the early subacute phase. A wider international use of FMA-UE will allow comparison of stroke recovery between regions and countries and thereby potentially improve the quality of care and rehabilitation in persons with stroke worldwide.