The minimal important change of the Fugl-Meyer Assessment lower extremity motor scale in patients with acute stroke.

Takuya Nakajima, Shiho Miyagi, Hideki Iwamatsu, Mizuki Ushijima, Yohei Yamato, Tetsuharu Nakazono, Satoru Amano, Ryota Mihira, Takehiro Shirota, Shoko Koseki, Kosuke Mizuno, Shinichi Obara, Kazutoshi Nishiyama, Michinari Fukuda, Kayoko Takahashi
Purpose:

This study aimed to calculate the MIC of FMA-LE in patients with acute stroke.

Methods:

This prospective study included 35 patients with acute stroke undergoing rehabilitation in inpatient stroke units. All patients underwent a baseline assessment with the FMA-LE within 5 days of admission to the stroke unit, followed by a follow-up assessment with the FMA-LE 2 weeks later. Patients completed the Global Rating of Change (GRC) at the follow-up assessment. The GRC scale asked patients, "In terms of your lower extremity motor paralysis and walking, how would you describe yourself now compared to when you were admitted”? We obtained two GRC scores from patients regarding their lower extremity motor paralysis and walking as anchors. The MIC were estimated using anchor-based methods (receiver operating characteristic [ROC] curves analysis) with the GRC as the anchor.


Results:

The improved group based on the patients for lower extremity motor paresis GRC score included 20 patients (57%), whereas the improved on the patients for walking GRC score included 24 patients (69%). The MIC cutoff value for lower extremity motor paralysis was 1.0 (area under the curve [AUC] = 0.77). The sensitivity and specificity of the MIC value are 100% and 47%, respectively. The MIC cutoff value for walking was 5.0 (AUC = 0.71). The sensitivity and specificity of the MIC value are 67% and 39%, respectively.

Conclusion(s):

The FMA-LE MIC obtained in this study is valuable for identifying clinically important improvements in walking among patients with acute stroke. Compared with previous studies in patients with acute stroke, the MIC for lower extremity motor paralysis was lower than the MDC value of 3.2 points, which raises doubts about its appropriateness as an MIC. On the other hand, the MIC for walking was higher than the MDC, so we believe that this can show a clinically meaningful improvement in FMA-LE in patients with acute stroke.

Implications:

Applying the 5.0 points as FMA-LE MIC regarding walking in rehabilitation practice for patients with acute stroke. The FMA-LE MIC for lower extremity function in patients with acute stroke was 1.0 points, which was lower than the MDC value in the previous study.

Funding acknowledgements:
There are no funding acknowledgments to disclose.
Keywords:
stroke rehabilitation
interpretability
outcome measure
Primary topic:
Neurology: stroke
Second topic:
Neurology
Third topic:
Disability and rehabilitation
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
This study was approved by the Kitasato University Hospital Research Ethics Committee.
Provide the ethics approval number:
Approval number: B23-069
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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