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The Fugl-Meyer Upper Extremity Scale

Article in Journal of Physiotherapy · October 2016

DOI: 10.1016/j.jphys.2016.08.010

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 Journal of Physiotherapy 63 (2017) 53
Journal of
PHYSIOTHERAPY
journal homepage: www.elsevier.com/locate/jphys
Appraisal
The Fugl-Meyer Upper Extremity Scale
Description
The Fugl-Meyer Upper Extremity (FMUE) Scale1 is a widely used
and highly recommended stroke-specific, performance-based
measure of impairment.2,3 It is designed to assess reflex activity,
movement control and muscle strength in the upper extremity of
people with post-stroke hemiplegia. It has been extensively used
as an outcome measure in rehabilitation trials and to record post-
stroke recovery, particularly in the USA.4
The FMUE Scale comprises 33 items, each scored on a scale of
0 to 2, where 0 = cannot perform, 1 = performs partially and
2 = performs fully. It is free, requires only household items for
testing, and takes up to 30 minutes to administer. Two illustrated
manuals outlining the assessed components of the scale and
scoring criteria have been published to address shortcomings of
the original description.5,6
The time taken to complete the full FMUE Scale has led
researchers to develop variants, including a distal upper extremity
sub-scale comprising 12 wrist/hand items7 and a ‘short form’ six-
item scale of the whole FMUE Scale, which was developed using
Rasch analysis to determine the easiest and most difficult items.8
In the development of the short form of the scale, care was taken to
preserve the original content representativeness, which is based on
sequential stages of post-stroke motor recovery, first documented
by Brunnstrom in 1966.9 However, the short form version has been
shown to be less sensitive to change at an individual level, which
limits its clinical utility.10
Extensive assessment of the psychometric properties of the
FMUE Scale has been undertaken.3 The longitudinal stability of
Commentary
Persistent upper extremity deficits are common following
stroke. Consequently, psychometrically sound outcome measures
that are also easy to use are essential to document change in upper
extremity function over time. Although the FMUE Scale has been
extensively utilised, shortcomings include that individual finger
movements are not assessed; consequently, deficits in distal fine
motor functions may be under-reported. Given the importance of
fractionated finger movement for many upper extremity functions,
this scale may be insufficiently sensitive to document change in
very high-functioning individuals. Conversely, the evaluation of
upper extremity reflexes, although criticised by some authors,4
provides the ability to detect small changes in the sensorimotor
system, which may be particularly useful in those with very
limited volitional movement in the acute phase of stroke. Another
advantage is the availability of detailed illustrated descriptions of
the scale, 5,6[14_TD$IF] which may facilitate use by researchers with a limited
clinical background.
http://dx.doi.org/10.1016/j.jphys.2016.08.010
1836-9553/ß 2016 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
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Clinimetrics
assessment items (apart from reflex evaluation) over 6 months has
been established, supporting the validity of the measure over
time.4 Excellent internal consistency (alpha = 0.94 to 0.98 across
four administrations over 6 months) has been demonstrated.11
Satisfactory concurrent validity has been shown in comparison
with three other commonly used measures of upper extremity
motor recovery.11 In this study, the FMUE Scale was the only tool
that did not have significant floor and ceiling effects, and intra-
rater (ICC 0.99, 95% CI 0.99 to 1.00) and inter-rater (ICC 0.96, 95% CI
0.92 to 0.98) agreement [12_TD$IF]were shown to be excellent. These authors
reported a minimal detectable change for intra-rater assessments
of 5.2 on the 66-point scale (8% of the total measure) and 12.9 (20%
of the total measure) for inter-rater assessments.
A range of data exists for minimal clinically important
differences for the FMUE Scale. A change of between 4 and
7 points in chronic stroke,7[1_TD$IF] and 9 to 10 points in subacute stroke12
is considered to be clinically significant. A recent study by
Hoonhorst et al13[1_TD$IF] aimed to determine the optimal cut-off scores
for the FMUE Scale regarding predictions of upper limb capacity at
6 months post stroke. These authors reported that FMUE Scale
scores < 31 corresponded with ‘no to poor’ upper extremity
capacity, while 32 to 47 represented ‘limited capacity’, 48 to
52 represented ‘notable capacity’ and 53 to 66 represented ‘full’
upper extremity capacity. Shelton et al14[1_TD$IF] reported that a 10-point
increase from admission to discharge on the FMUE Scale
corresponded to a 1.5[13_TD$IF]-point change on the Functional Indepen-
dence Measure.
Barbara Singer and Jimena Garcia-Vega
School of Surgery, Faculty of Medicine, Dentistry and Health Science,
The University of Western Australia, Perth, Australia
References
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2. van Wijck FM, et al. Neurorehabil Neural Repair. [2_TD$IF]2001;15:23–30.
3. Gladstone D, et al. Neurorehabil Neural Repair. [3_TD$IF]2002;13:232–240.
4. Woodbury ML, et al. Arch Phys Med Rehabil. [4_TD$IF]2008;89:1563–1569.
5. Deakin A, et al. Physiotherapy. [5_TD$IF]2003;89:751–763.
6. Sullivan KJ, et al. Stroke. [6_TD$IF]2011;42:427–432.
7. Page SJ, et al. Arch Phys Med Rehabil. [5_TD$IF]2012;93:2373–2376.
8. Hsieh YW, et al. Stroke. [7_TD$IF]2007;38:3052–3054.
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13. Hoonhorst MH, et al. Arch Phys Med Rehabil. [10_TD$IF]2015;96:1845–1849.
14. Shelton FD, et al. Neurorehabil Neural Repair. [3_TD$IF]2001;15:229–237.