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Published on: September 1, 2023
The Minimal Important Change of the Fugl-Meyer Assessment-Lower Extremity Motor Scale in Patients With Acute Stroke
Tetsuharu Nakazono1, Satoru Amano2, Ryota Mihira3
1Department of Rehabilitation, Kitasato University Hospital, Kanagawa, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.
Objective:
To estimate anchor-based minimal important change (MIC) values for the Fugl-Meyer assessment-lower extremity (LE) in patients with acute stroke from the perspectives of patients and physiotherapists using the ROC method (MICROC) and adjusted MIC (MICadjusted).
Design:
Prospective cohort study.
Setting:
Stroke care unit at a single acute care hospital.
Participants:
Adults with acute stroke analyzed (n=100); baseline assessment within 5 days of onset and follow-up at 2 weeks.
Interventions:
Not applicable.
Main Outcome Measures:
The Fugl-Meyer assessment-LE, Short Physical Performance Battery, and Functional Ambulation Category were assessed within 5 days and at 2 weeks after stroke onset. The anchors were the 7-point Global Rating of Change (GRC) Scale for LE motor function and walking among the patients and physiotherapists. Patient- and physiotherapist-rated GRC scores were assessed at 2 weeks. Patients' and physiotherapists' perspectives on GRC were divided into 2 groups based on meaningful improvement (GRC≥6). Then, the MICROC and MICadjusted values of the Fugl-Meyer assessment-LE were calculated.
Results:
The MICROC values were 3.5 points (95% confidence interval [CI], 0.5-7.5) for patient-rated GRC (LE motor function) and 3.5 (1.5-7.5) for patient-rated GRC (walking). The MICROC values were 1.5 points (0.5-6.5) for therapist-rated GRC (LE motor function) and 3.5 (0.5-7.5) for therapist-rated GRC (walking). The MICadjusted values for patient-rated LE motor function and walking were both 4.3 points (3.7-4.9). The MICadjusted values for physiotherapist-rated LE motor function and walking were 3.3 (2.4-4.1) to 3.8 points (3.0-4.4), respectively.
Conclusions:
The MICadjusted values were more robust than the MICROC values. The MICadjusted value from the physiotherapist's perspective was lower than that from the patient's perspective. These MIC values may be helpful for setting rehabilitation goals and evaluating interventions objectively, thereby providing important benchmarks for clinical decision-making in acute stroke rehabilitation.
Insights
This study determined minimal important change (MIC) values for the Fugl-Meyer Assessment-Lower Extremity (FMA-LE) in acute stroke patients. Bias-adjusted MIC values offer robust benchmarks for rehabilitation goal setting and intervention evaluation.
Area of Science:
- Neurology and Rehabilitation Medicine
- Clinical Measurement and Outcomes Research
Background:
- Accurate assessment of functional recovery after stroke is crucial for effective rehabilitation.
- The Fugl-Meyer Assessment-Lower Extremity (FMA-LE) is a common tool, but its minimal important change (MIC) requires precise estimation.
- Understanding patient and therapist perspectives is vital for interpreting FMA-LE score changes.
Purpose of the Study:
- To estimate anchor-based minimal important change (MIC) values for the FMA-LE in acute stroke.
- To compare MIC values derived from patient and physiotherapist perspectives using receiver operating characteristic (MICROC) and bias-adjusted predictive modeling (MICadjusted).
- To establish reliable benchmarks for evaluating lower extremity motor function recovery post-stroke.
Main Methods:
- Prospective cohort study involving 100 adult acute stroke patients.
- FMA-LE, Short Physical Performance Battery, and Functional Ambulation Category assessed at baseline and 2 weeks post-stroke.
- Global Rating of Change (GRC) scale used as an anchor for patient and therapist-rated meaningful improvement (GRC ≥ 6).
Main Results:
- MICadjusted values for patient-rated lower extremity (LE) motor function and walking were 4.3 points.
- MICadjusted values for physiotherapist-rated LE motor function and walking ranged from 3.3 to 3.8 points.
- MICadjusted values were found to be more robust than MICROC values.
Conclusions:
- Bias-adjusted MIC values provide more reliable estimates for FMA-LE changes in acute stroke.
- Physiotherapist-rated MICadjusted values were generally lower than patient-rated values.
- These MIC values serve as important benchmarks for setting rehabilitation goals and objectively evaluating interventions in acute stroke care.
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