Highlights
- •The lower extremity Fugl-Meyer Assessment represents a multidimensional construct.
- •Our results challenge use of the total score to predict lower extremity motor recovery.
- •The abnormal synergy items of the lower extremity Fugl-Meyer Assessment are unidimensional.
- •The abnormal synergy items deviate from the originally proposed hierarchical order.
Abstract
Objective
To investigate the dimensionality and item-difficulty hierarchy of the Fugl-Meyer
Assessment of the lower extremity (FMA-LE).
Design
Secondary analyses of data pooled from 4 existing datasets: a phase III randomized
controlled trial investigating the effectiveness of body weight support and a treadmill
for rehabilitation of walking poststroke, and 3 cross-sectional studies investigating
the link between impaired motor performance poststroke and walking.
Setting
University research centers and rehabilitation centers.
Participants
A pooled sample of individuals with a stroke (N=535, men=313; mean age ± SD, 61.91±12.42y).
Interventions
Not applicable.
Main Outcome Measures
Confirmatory factor analyses (CFA) and Rasch residual principal component analysis
(PCA) investigated the dimensionality of the FMA-LE. The Rasch analysis rating scale
model investigated item-difficulty hierarchy of the FMA-LE.
Results
The CFA showed adequate fit of a 3-factor model, with 2 out of 3 indices (CFA=.95;
Tucker-Lewis Index=.94; root mean square error of approximation=.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, rating scale model results
revealed deviations in the item-difficulty hierarchy of the unidimensional abnormal
synergy items from the originally proposed stepwise sequence of motor recovery.
Conclusions
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
composed of the abnormal synergy items. However, this unidimensional scale deviates
from the originally proposed hierarchical ordering.
Keywords
List of abbreviations:
CFA (confirmatory factor analysis), CFI (comparative fit index), FMA (Fugl-Meyer Assessment), FMA-LE (Fugl-Meyer Assessment of the lower extremity), MNSQ (mean square), PCA (principal component analysis), RMSEA (root mean square error of approximation), TLI (Tucker-Lewis Index)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 28, 2015
Footnotes
Support for study 1 by the National Institute of Neurologic Diseases and Stroke and the National Center for Medical Rehabilitation Research (grant no. RO1 NS050506); for study 2, by the National Institutes of Health (grant no. HD46820); for study 3, by the Rehabilitation Research and Development Service of the U.S. Department of Veterans Affairs (grant no. B2748R); and for study 4, by an Institutional Development Award from the National Institute of General Medical Sciences of the National Institutes of Health (grant no. P20-GM109040).
Disclosures: none.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
