Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer Assessment in minimally impaired upper extremity hemiparesis in stroke

Abstract

There is a need for time-efficient, valid measures of distal paretic upper extremity (UE) movement. The purposes of this study were to (1) determine the psychometric properties of the wrist stability and mobility and wrist/hand scale of the upper extremity Fugl-Meyer (w/h UE FM) as a "stand-alone" measure of distal UE movement; and (2) provide detailed instructions on w/h UE FM administration and scoring. The upper extremity Fugl Meyer (UE FM) and Action Research Arm Test (ARAT) were administered on 2 separate occasions to each of 29 subjects exhibiting stable, mild UE hemiparesis (23 men; mean age ± SD, 60.8±12.3 y; mean time since stroke onset for subjects in the sample, 36.0 mo). Fifty-eight observations were collected on each measure. w/h UE FM internal consistency levels (measured by Cronbach α) were high (.90 and .88 for first and second testing sessions, respectively). The intraclass correlation coefficient for the UE FM was .98, while the intraclass correlation coefficient for the w/h UE FM was .97. Concurrent validity measured by Spearman correlation was moderately high between the w/h UE FM and ARAT (.72, P<.001). From these data, it appears that the w/h UE FM is a promising tool to measure distal UE movement in minimally impaired stroke, although more research with a larger sample is needed. A standardized approach to UE test administration is critical to accurate score interpretation across patients and trials. Thus, the article also provides instructions and pictures for w/h UE FM administration and scoring.