Table_1_Item Difficulty of Fugl-Meyer Assessment for Upper Extremity in Persons With Chronic Stroke With Moderate-to-Severe Upper Limb Impairment.docx

Background and Purpose: Limited research has been conducted with the aim of understanding which upper extremity movements are difficult for persons with severe chronic stroke. The purpose of this study was to test the structure of the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) using Rasch analysis in persons with chronic stroke with moderate to severe deficits and to determine the item difficulty hierarchy.
Methods: This was a secondary analysis of data from previous randomized, controlled trials, or clinical trials. The participants were 101 persons with chronic stroke with moderate to severe hemiparesis (time after onset of stroke, 1375.3 ± 1157.9 days; the 33-item FMA-UE, 31.1 ± 12.8). Principal component analysis and infit statistics were used to evaluate dimensionality. Rasch analysis using a rating scale model was performed, and item difficulty was determined.
Results: Six misfit items were removed. The results showed that the 27-item FMA-UE was unidimensional. Rasch analysis showed that the movements performed within synergies were among the easiest items. Shoulder and elbow movements were among the easiest items, whereas forearm and wrist movements were among the moderately to most difficult items. Hand items spanned various difficulty levels.
Discussion and Conclusions: The FMA-UE is a valid assessment tool of upper extremity motor function in persons with chronic stroke with moderate to severe deficits. The results showed that item difficulty was consistent with the stepwise recovery course proposed by Fugl-Meyer. The movements that are difficult for patients with moderate to severe chronic paresis were determined, which would enable comparison of each movement using a measure of motion difficulty in future studies.

背景与目的：目前针对重度慢性脑卒中患者难以完成的上肢运动类型的相关研究尚较为匮乏。本研究旨在采用拉什分析（Rasch analysis）方法，针对存在中至重度运动功能缺损的慢性脑卒中患者，验证上肢Fugl-Meyer评估量表（Fugl-Meyer Assessment for Upper Extremity, FMA-UE）的结构，并明确其条目难度层级。
方法：本研究为对既往随机对照试验或临床试验数据的二次分析。共纳入101例存在中至重度偏瘫的慢性脑卒中患者（卒中发病时长：1375.3±1157.9天；33条目版FMA-UE评分：31.1±12.8）。采用主成分分析与拟合统计量评估量表的单维性，使用等级反应模型开展拉什分析，并确定各条目难度。
结果：共剔除6个拟合不佳条目。结果显示，27条目版FMA-UE具备单维结构。拉什分析结果表明，协同运动模式内的动作属于较易完成的条目；肩关节与肘关节运动亦为较易完成的项目，而前臂与腕关节运动则属于中等至最难完成的条目；手部相关条目覆盖了多种难度层级。
讨论与结论：FMA-UE是评估中至重度运动功能缺损的慢性脑卒中患者上肢运动功能的有效测评工具。本研究结果显示，条目难度与Fugl-Meyer提出的逐步恢复进程相符。本研究明确了中至重度慢性偏瘫患者难以完成的运动类型，可为未来研究中采用运动难度量化指标对比各类运动提供依据。