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Psychometric Comparisons of 2 Versions of the Fugl-Meyer Motor Scale and 2 Versions of the Stroke Rehabilitation Assessment of Movement

School of Occupational Therapy, College of Medicine, National Taiwan University and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan

Miao-Ju Hsu, PhD

Faculty of Physical Therapy, College of Health Science, Kaohsiung Medical University and Department of Rehabilitation, Kaohsiung Medical University Hospital, Taiwan

Ching-Fan Sheu, PhD

Institute of Cognitive Science, National Cheng Kung University, Taiwan

Su Lee, MS

Department of Rehabilitation, Kaohsiung Medical University Hospital, Taiwan

Ching-Lin Hsieh, PhD

School of Occupational Therapy, College of Medicine, National Taiwan University and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan

Jau-Hong Lin, PhD

Faculty of Physical Therapy, College of Health Science, Kaohsiung Medical University and Department of Rehabilitation, Kaohsiung Medical University Hospital, Taiwan, jhlin{at}kmu.edu.tw

Objective. To provide empirical justification for selecting motor scales for stroke patients, the authors compared the psychometric properties (validity, responsiveness, test-retest reliability, and smallest real difference [SRD]) of the Fugl-Meyer Motor Scale (FM), the simplified FM (S-FM), the Stroke Rehabilitation Assessment of Movement instrument (STREAM), and the simplified STREAM (S-STREAM). Methods. For the validity and responsiveness study, 50 inpatients were assessed with the FM and the STREAM at admission and discharge to a rehabilitation department. The scores of the S-FM and the S-STREAM were retrieved from their corresponding scales. For the test-retest reliability study, a therapist administered both scales on a different sample of 60 chronic patients on 2 occasions. Results. Only the S-STREAM had no notable floor or ceiling effects at admission and discharge. The 4 motor scales had good concurrent validity (rho .91) and satisfactory predictive validity (rho = .72-.77). The scales showed responsiveness (effect size d 0.34; standardized response mean 0.95; P < .0001), with the S-STREAM most responsive. The test-retest agreements of the scales were excellent (intraclass correlation coefficients .96). The SRD of the 4 scales was 10% of their corresponding highest score, indicating acceptable level of measurement error. The upper extremity and the lower extremity subscales of the 4 showed similar results. Conclusions. The 4 motor scales showed acceptable levels of reliability, validity, and responsiveness in stroke patients. The S-STREAM is recommended because it is short, responsive to change, and able to discriminate patients with severe or mild stroke.

Key Words: Stroke • Motor recovery • Outcome measures • Psychometrics.

This version was published on November 1, 2008

Neurorehabilitation and Neural Repair, Vol. 22, No. 6, 737-744 (2008)
DOI: 10.1177/1545968308315999


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