Page Stephen J, Hade Erinn, Persch Andrew
S.J. Page, PhD, MS, MOT, OTR/L, FAHA, School of Health and Rehabilitation Sciences, Ohio State University, 453 W Tenth Ave, Columbus, OH 43210 (USA).
E. Hade, PhD, Biostatistics, Ohio State University.
Phys Ther. 2015 Jan;95(1):103-8. doi: 10.2522/ptj.20130235. Epub 2014 Sep 4.
There remains a need for a quickly administered, stroke-specific, bedside measure of active wrist and finger movement for the expanding stroke population. The wrist stability and hand mobility scales of the upper extremity Fugl-Meyer Assessment (w/h UE FM) constitute a valid, reliable measure of paretic UE impairment in patients with active wrist and finger movement.
The aim of this study was to determine performance on the w/h UE FM in a stable cohort of survivors of stroke with only palpable movement in their paretic wrist flexors.
A single-center cohort study was conducted.
Thirty-two individuals exhibiting stable, moderate upper extremity hemiparesis (15 male, 17 female; mean age=56.6 years, SD=10.1; mean time since stroke=4.6 years, SD=5.8) participated in the study, which was conducted at an outpatient rehabilitation clinic in the midwestern United States. The w/h UE FM and Action Research Arm Test (ARAT) were administered twice. Intraclass correlation coefficients (ICCs), Cronbach alpha, and ordinal alpha were computed to determine reliability, and Spearman rank correlation coefficients and Bland-Altman plots were computed to establish validity.
Intraclass correlation coefficients for the w/h UE FM and ARAT were .95 and .99, respectively. The w/h UE FM intrarater reliability and internal consistency were greater than .80, and concurrent validity was greater than .70. This also was the first stroke rehabilitative study to apply ordinal alpha to examine internal consistency values, revealing w/h UE FM levels greater than .85. Concurrent validity findings were corroborated by Bland-Altman plots.
It appears that the w/h UE FM is a promising tool to measure distal upper extremity movement in patients with little active paretic wrist and finger movement. This finding widens the segment of patients on whom the w/h UE FM can be effectively used and addresses a gap, as commonly used measures necessitate active distal upper extremity movement.
对于不断增加的中风患者群体，仍需要一种能够快速实施的、针对中风的、用于评估主动腕部和手指运动的床边测量方法。上肢Fugl-Meyer评估中的腕部稳定性和手部活动度量表（w/h UE FM）是对有主动腕部和手指运动的患者的偏瘫上肢功能障碍进行有效、可靠测量的方法。
本研究旨在确定仅能触及患侧腕屈肌运动的中风幸存者稳定队列在w/h UE FM上的表现。
进行了一项单中心队列研究。
32名表现为稳定、中度上肢偏瘫的个体（15名男性，17名女性；平均年龄=56.6岁，标准差=10.1；中风后平均时间=4.6年，标准差=5.8）参与了该研究，研究在美国中西部的一家门诊康复诊所进行。w/h UE FM和动作研究上肢测试（ARAT）进行了两次。计算组内相关系数（ICC）、克朗巴哈系数和有序系数以确定可靠性，并计算斯皮尔曼等级相关系数和布兰德-奥特曼图以建立效度。
w/h UE FM和ARAT的组内相关系数分别为0.95和0.99。w/h UE FM的评分者内信度和内部一致性大于0.80，同时效度大于0.70。这也是第一项应用有序系数来检验内部一致性值的中风康复研究，结果显示w/h UE FM水平大于0.85。布兰德-奥特曼图证实了同时效度的结果。
w/h UE FM似乎是一种很有前景的工具，可用于测量患侧腕部和手指主动运动较少的患者的上肢远端运动。这一发现扩大了w/h UE FM能够有效应用的患者群体范围，并填补了一项空白，因为常用测量方法需要上肢远端有主动运动。
