Intra- and inter-rater reliability of Fugl-Meyer Assessment of Lower Extremity early after stroke.
Edgar D Hernández, Sandra M Forero, Claudia P Galeano and 3 others
PMID 33358073WHAT IT FOUND
The Colombian Spanish FMA-LE rated leg movement after stroke reliably early in hospital.
Between therapists, total score agreement was 75% to 80%. Within therapists, agreement was 69% to 87% when a 1-point difference was accepted.
Key findings
01Between therapists, item agreement was above 88%, and total E-F score agreement was 75% to 80%.
02Within the same therapist, exact total E-F score agreement was 47% to 51%, but agreement was 69% to 87% when a 1-point difference was accepted.
03Within-rater systematic disagreement was significant for ankle dorsiflexion within synergies in supine position and for normal reflex activity in one rater.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Patients were hospitalized 4 to 9 days after stroke, so results apply mainly to acute and subacute inpatient care, not chronic or outpatient settings. All raters were physical therapists with more than 20 years of experience and prior FMA-LE training, so agreement may not hold for less experienced or untrained raters. The same therapist was retested only one day apart, and higher scores were sometimes used on the second occasion; early recovery or learning may have influenced agreement. The study used a rank invariant method rather than the COSMIN-recommended weighted kappa, so comparisons with older ICC or kappa studies are not direct.
Declared interests
The author declares no conflicts of interest.
The easy way to misread this
Do not conclude that every total FMA-LE score change is real improvement. Exact same-therapist total score agreement was only 47% to 51%, and agreement reached 69% to 87% when a 1-point difference was accepted.