658
E. D. Hernández et al.
synthesize evidence (11). Increased effort is, however,
needed to improve uniform assessment of FME-UE
across different clinical and research sites across the
world. This can be achieved by increased awareness
of modifications made to the original scale, but also
improved access to the scoring protocols, manuals
and training materials used in different countries and
languages. The original FMA-UE scale approved by
the Axel Fugl-Meyer, the official translations and an
instruction video on how to perform the testing are
freely available for non-profit use (www.neurophys.
gu.se/rehabmed) to any clinical or research setting
around the world. All these efforts are important to
achieve a more standardized use of the scale.
In conclusion, the FMA-UE showed excellent
inter- and intra-rater reliability in the assessment of
sensorimotor function in the acute/subacute phase
after stroke. Systematic disagreements were detected
only in 4 items of the shoulder section. The agreement
was excellent at the item level and satisfactory at the
subscale and total score level. The findings from the
current study, confirming the reliability of the single
items of the FMA-UE, might be used as guidance in
future studies on stroke recovery. In addition to recom-
mendation of use of the scale in Colombian patient po-
pulations, it can be recommended as a reliable clinical
assessment tool for use in other clinical and research
settings. Wider international use of the FMA-UE has
the potential to improve physiotherapists’ evaluations
of motor impairments in patients with stroke, and to
enable comparisons of stroke populations between
different countries.
ACKNOWLEDGEMENTS
The authors wish to express their appreciation to the Central
Military Hospital of Colombia, Universidad Nacional de
Colombia and the patients who participated in the study. This
publication is in memory of Nancy Stella Landinez Parra who
was one of the initiators of the study, and took active part in the
study planning and data collection.
Funding: This project was funded by the Central Military
Hospital through Research Project Number 2013059, registered
with the Research Unit; the grant for strengthening established
partnerships 2017 at University of Gothenburg; the Swedish
state under the agreement between the Swedish government and
the country councils, the ALF-agreement (ALFGBG-775561,
ALFGBG-718711); Swedish Research Council (VR2017-
00946).
The authors have no conflicts of interest to declare.
REFERENCES
1. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation.
Lancet 2011; 377: 1693–1702.
2. Langhorne P, Coupar F, Pollock A. Motor recovery after
www.medicaljournals.se/jrm
stroke: a systematic review. Lancet Neurology 2009; 8:
741–754.
3. Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS.
Recovery of upper extremity function in stroke patients:
the Copenhagen Stroke Study. Arch Phys Med Rehabil
1994; 75: 394–398.
4. Persson HC, Parziali M, Danielsson A, Sunnerhagen KS.
Outcome and upper extremity function within 72 hours
after first occasion of stroke in an unselected population at
a stroke unit. A part of the SALGOT study. BMC Neurology
2012; 12: 162.
5. Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG,
Howard R, et al. Estimates of the prevalence of acute
stroke impairments and disability in a multiethnic popula-
tion. Stroke 2001; 32: 1279–1284.
6. Broeks JG, Lankhorst GJ, Rumping K, Prevo AJ. The long-
term outcome of arm function after stroke: results of a
follow-up study. Disabil Rehabil 1999; 21: 357–364.
7. Parker VM, Wade DT, Langton Hewer R. Loss of arm fun-
ction after stroke: measurement, frequency, and recovery.
Int Rehabil Med 1986; 8: 69–73.
8. Bernal MYP. [Alterations in motor function of upper limbs
in hemiplegia - physiotherapy intervention models.] Movi-
miento Científico 2009; 3: 101–108. (In Spanish).
9. Kwakkel G, Lannin NA, Borschmann K, English C, Ali M,
Churilov L, et al. Standardized measurement of sensorimo-
tor recovery in stroke trials: consensus-based core recom-
mendations from the Stroke Recovery and Rehabilitation
Roundtable. Int J Stroke 2017; 12: 451–461.
10. Alt Murphy M, Resteghini C, Feys P, Lamers I. An overview
of systematic reviews on upper extremity outcome mea-
sures after stroke. BMC Neurol 2015; 15: 29.
11. Duncan Millar J, van Wijck F, Pollock A, Ali M. Outcome
measures in post-stroke arm rehabilitation trials: do
existing measures capture outcomes that are important
to stroke survivors, carers, and clinicians? Clin Rehabil
2019; 33: 737–749.
12. Crow JL, Kwakkel G, Bussmann JB, Goos JA, Harmeling-van
der Wel BC, Early prediction of functional outcome after
stroke I. Are the hierarchical properties of the Fugl-Meyer
assessment scale the same in acute stroke and chronic
stroke? Phys Ther 2014; 94: 977–986.
13. Lin JH, Hsu MJ, Sheu CF, Wu TS, Lin RT, Chen CH, et al.
Psychometric comparisons of 4 measures for assessing
upper-extremity function in people with stroke. Phys Ther
2009; 89: 840–850.
14. See J, Dodakian L, Chou C, Chan V, McKenzie A, Rein-
kensmeyer DJ, et al. A standardized approach to the Fugl-
Meyer assessment and its implications for clinical trials.
Neurorehabil Neural Repair 2013; 27: 732–741.
15. Page SJ, Levine P, Hade E. Psychometric properties and
administration of the wrist/hand subscales of the Fugl-
Meyer Assessment in minimally impaired upper extremity
hemiparesis in stroke. Arch Phys Med Rehabil 2012; 93:
2373–2376 e2375.
16. Michaelsen SM, Rocha AS, Knabben RJ, Rodrigues LP,
Fernandes CG. Translation, adaptation and inter-rater
reliability of the administration manual for the Fugl-Meyer
assessment. Rev Bras Fisioter 2011; 15: 80–88.
17. Lundquist CB, Maribo T. The Fugl-Meyer assessment of the
upper extremity: reliability, responsiveness and validity of
the Danish version. Disabil Rehabil 2017; 39: 934–939.
18. Svensson E, Schillberg B, Kling AM, Nystrom B. Reliability
of the balanced inventory for spinal disorders, a questionn-
aire for evaluation of outcomes in patients with various
spinal disorders. J Spinal Disord Tech 2012; 25: 196–204.
19. Amano S, Umeji A, Uchita A, Hashimoto Y, Takebayashi
T, Kanata Y, et al. Reliability of remote evaluation for the
Fugl-Meyer assessment and the action research arm test
in hemiparetic patients after stroke. Top Stroke Rehabil
2018; 25: 432–437.
20. Nijland RH, van Wegen EE, Harmeling-van der Wel BC,