Dimensionality and item-difficulty hierarchy of the lower-extremity Fugl-Meyer assessment in individuals with sub-acute and chronic stroke

Publication date: Available online 29 December 2015
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Chitralakshmi K. Balasubramanian, Chih-Ying Li, Mark G. Bowden, Pamela W. Duncan, Steven A. Kautz, Craig A. Velozo
ObjectiveTo investigate the dimensionality and item-difficulty hierarchy of the lower extremity section of the Fugl-Meyer assessment (FMA-LE).DesignSecondary analyses of data pooled from four existing datasets: a Phase III randomized controlled trial investigating the effectiveness of body weight support and a treadmill for rehabilitation of walking post-stroke and three cross-sectional studies investigating the link between impaired motor performance post-stroke and walking.SettingUniversity research centers and rehabilitation centers.ParticipantsA pooled sample of 535 individuals with a stroke (age = 61.91 ± 12.42 years; male = 313).InterventionsNot applicable.Main Outcome Measure(s)Confirmatory factor analyses (CFA) and Rasch residual Principal component analysis (PCA) investigated the dimensionality of the FMA-LE. The Rasch analysis rating scale model (RSM) investigated item-difficulty hierarchy of the FMA-LE.ResultsThe CFA showed adequate fit of a three-factor model with 2/3 indices (CFA = 0.95; TLI = 0.94; RMSEA = 0.124) showing good model fit. Rasch PCA showed that removal of the reflex and coordination items explained 90.8% of variance in the data, suggesting that the abnormal synergy items contributed to the measurement of a unidimensional construct. However, RSM results revealed deviations in the item-difficulty hierarchy of the unidimensional abnormal synergy items from the originally proposed stepwise sequence of motor recovery.Conclusion(s)Our findings suggest that the FMA-LE might represent a multidimensional construct challenging the use of a total score of the FMA-LE to predict lower extremity motor recovery. Removal of the misfit items resulted in creation of a unidimensional scale comprised of the abnormal synergy items. However, this unidimensional scale deviates from the originally proposed hierarchical ordering.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RPonNn
via IFTTT