The Czech Fugl-Meyer assessment for post-stroke sensorimotor function: translation and cross-cultural adaptation and validation
Language English Country Sweden Media electronic
Document type Journal Article, Validation Study
PubMed
40336222
PubMed Central
PMC12079045
DOI
10.2340/jrm.v57.43010
Knihovny.cz E-resources
- MeSH
- Stroke * physiopathology MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Pilot Projects MeSH
- Disability Evaluation * MeSH
- Translations MeSH
- Stroke Rehabilitation * MeSH
- Reproducibility of Results MeSH
- Aged MeSH
- Cross-Cultural Comparison MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Validation Study MeSH
- Geographicals
- Czech Republic MeSH
OBJECTIVE: To ensure wider use of the internationally recommended Fugl-Meyer Assessment (FMA) of sensorimotor function for people with stroke, official translations of the scale are needed. This study aimed to perform a translation and cross-cultural adaptation/validation of the FMA into the Czech language. DESIGN: Translation and cross-cultural adaptation/validation. SUBJECTS/PATIENTS: Five clinical experts and 1 external expert participated as reviewers; 11 individuals with stroke in the early subacute phase were included in the pilot testing. METHODS: A standardized process using forward-backward translations, expert panel reviews, and pilot testing between and within the raters (inter- and intra-rater reliability) were employed to ensure conceptual, semantic, and operational validity of the new Czech FMA. Agreement between raters was assessed in 11 individuals with stroke on 2 consecutive days at University Hospital Olomouc by using Svensson's rank-based statistics. RESULTS: Percentage of agreement between and within raters ranged between 70-100% and 55-100%, respectively. Systematic disagreements, found in 7 out of 96 FMA items, were discussed and revised in the final version. CONCLUSION: The Czech FMA offers a more unified and standardized assessment of sensorimotor impairment in clinical and research settings. This will improve stroke rehabilitation care and allow for wider international collaboration.
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Feigin VL, Brainin M, Norrving B, et al. . World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke 2025; 20: 132–144. 10.1177/17474930241308142 PubMed DOI PMC
Gialanella B, Santoro R, Ferlucci C. Predicting outcome after stroke: the role of basic activities of daily living predicting outcome after stroke. Eur J Phys Rehabil Med 2013; 49: 629–637. PubMed
Bryndziar T, Šedová P, Mikulík R. Stroke incidence in Europe: a systematic review. Cesk Slov Neurol N 2017; 80: 180–189. 10.14735/amcsnn2017180 DOI
Institute of Health Information and Statistics of the Czech Republic (ÚZIS) . Zdravotnická ročenka 2021 [retrieved 2023 June 23]. Available from: https://www.uzis.cz/index.php?pg=aktuality&aid=8619
Thayabaranathan T, Kim J, Cadilhac DA, Thrift AG, Donnan GA, Howard G, et al. . Global stroke statistics 2022. Int J Stroke 2022; 17: 946–956. 10.1177/17474930221123175 PubMed DOI PMC
Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol 2009; 8: 741–754. 10.1016/S1474-4422(09)70150-4 PubMed DOI
Alt Murphy M, Danielsson A, Sunnerhagen KS. Letter by Murphy et al. regarding article, “Fugl–Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials”. Stroke 2011; 42: e402. 10.1161/STROKEAHA.111.619304 PubMed DOI
Burridge J, Alt Murphy M, Buurke J, Feys P, Keller T, Klamroth-Marganska V, et al. . A systematic review of international clinical guidelines for rehabilitation of people with neurological conditions: what recommendations are made for upper limb assessment? Front Neurol 2019; 10: 567. 10.3389/fneur.2019.00567 PubMed DOI PMC
Santisteban L, Térémetz M, Bleton JP, Baron JC, Maier MA, Lindberg PG. Upper limb outcome measures used in stroke rehabilitation studies: a systematic literature review. PLoS One 2016; 11: e0154792. 10.1371/journal.pone.0154792 PubMed DOI PMC
Hernández ED, Galeano CP, Barbosa NE, Forero SM, Nordin Å, Sunnerhagen KS, et al. . Intra- and inter-rater reliability of Fugl–Meyer Assessment of Upper Extremity in stroke. J Rehabil Med 2019; 51: 652–659. 10.2340/16501977-2590 PubMed DOI
Hernández ED, Forero SM, Galeano CP, Barbosa NE, Sunnerhagen KS, Alt Murphy M. Intra- and inter-rater reliability of Fugl–Meyer Assessment of Lower Extremity early after stroke. Braz J Phys Ther 2020; 25: 709–718. 10.1016/j.bjpt.2020.12.002 PubMed DOI PMC
See J, Dodakian L, Chou C, Chan V, McKenzie A, Reinkensmeyer DJ, et al. . A standardized approach to the Fugl–Meyer assessment and its implications for clinical trials. Neurorehabil Neural Repair 2013; 27: 732–741. 10.1177/1545968313491000 PubMed DOI
Amano S, Umeji A, Uchita A, Hashimoto Y, Takebayashi T, Kanata Y, et al. . Reliability of remote evaluation for the Fugl–Meyer assessment and the action research arm test in hemiparetic patients after stroke. Top Stroke Rehabil 2018; 25: 43–47. 10.1080/10749357.2018.1484987 PubMed DOI
International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland: World Health Organization; 2001.
Kwakkel G, Lannin NA, Borschmann K, English C, Ali M, Churilov L, et al. . Standardized measurement of sensorimotor recovery in stroke trials: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2017; 31: 784–792. 10.1177/1545968317732662 PubMed DOI
Lee HC, Kuo FL, Lin YN, Liou TH, Lin JC, Huang SW. Effects of robot-assisted rehabilitation on hand function of people with stroke: a randomized, crossover-controlled, assessor-blinded study. Am J Occup Ther 2021; 75: 7501205020p1–7501205020p11. 10.5014/ajot.2021.038232 PubMed DOI
Hernandez A, Bubyr L, Archambault PS, Higgins J, Levin MF, Kairy D. Virtual reality-based rehabilitation as a feasible and engaging tool for the management of chronic poststroke upper-extremity function recovery: randomized controlled trial. JMIR Serious Games 2022; 10: e37506. 10.2196/37506 PubMed DOI PMC
Park J, Lee N, Cho M, Kim D, Yang Y. Effects of mental practice on stroke patients’ upper extremity function and daily activity performance. J Phys Ther Sci 2015; 27: 1075–1077. 10.1589/jpts.27.1075 PubMed DOI PMC
Rocha LSO, Gama GCB, Rocha RSB, Rocha LB, Dias CP, Santos LLS, et al. . Constraint induced movement therapy increases functionality and quality of life after stroke. J Stroke Cerebrovasc Dis 2021; 30: 105774. 10.1016/j.jstrokecerebrovasdis.2021.105774 PubMed DOI
Hara T, Niimi M, Yamada N, Shimamoto Y, Masuda G, Hara H, et al. . Prognosis prediction of the effect of botulinum toxin therapy and intensive rehabilitation on the upper arm function in post-stroke patients using hierarchical cluster analysis. Disabil Rehabil 2022; 44: 6815–6823. 10.1080/09638288.2021.1977394 PubMed DOI
Fugl–Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med 1975; 7: 13–31. 10.2340/1650197771331 PubMed DOI
Sullivan JE, Crowner BE, Kluding PM, Nichols D, Rose DK, Yoshida R, et al. . Outcome measures for individuals with stroke: process and recommendations from the American Physical Therapy Association neurology section task force. Phys Ther 2013; 93: 1383–1396. 10.2522/ptj.20120492 PubMed DOI
Cruchinho P, López-Franco MD, Capelas ML, Almeida S, Bennett PM, Miranda da Silva M, et al. . Cross-cultural adaptation, and validation of measurement instruments: a practical guideline for novice researchers. J Multidiscip Healthc 2024; 17: 2701–2728. 10.2147/JMDH.S419714 PubMed DOI PMC
Busk H, Alt Murphy M, Korsman R, Skou ST, Wienecke T. Cross-cultural translation and adaptation of the Danish version of the Fugl–Meyer assessment for post stroke sensorimotor function. Disabil Rehabil 2022; 44: 4888–4895. 10.1080/09638288.2021.1919215 PubMed DOI
Cecchi F, Carrabba C, Bertolucci F, Castagnoli C, Falsini C, Gnetti B, et al. . Transcultural translation and validation of Fugl–Meyer assessment to Italian. Disabil Rehabil 2021; 43: 3717–3722. 10.1080/09638288.2020.1746844 PubMed DOI
Kim TL, Hwang SH, Lee WJ, Hwang JW, Cho I, Kim EH, et al. . The Korean version of the Fugl–Meyer Assessment: reliability and validity evaluation. Ann Rehabil Med 2021; 45: 83–98. 10.5535/arm.20225 PubMed DOI PMC
Onose G, Anghelescu A, Ionescu A, Tataranu LG, Spînu A, Bumbea AM, et al. . Translation of the Fugl–Meyer assessment into Romanian: transcultural and semantic-linguistic adaptations and clinical validation. Front Neurol 2023; 13: 1022546. 10.3389/fneur.2022.1022546 PubMed DOI PMC
Barbosa NE, Forero SM, Galeano CP, Hernández ED, Landinez NS, Sunnerhagen KS, et al. . Translation and cultural validation of clinical observational scales: the Fugl–Meyer assessment for post stroke sensorimotor function in Colombian Spanish. Disabil Rehabil 2019; 41: 2317–2323. 10.1080/09638288.2018.1464604 PubMed DOI
Ikram M, Rehman S, Sunnerhagen K, Alt Murphy M. Urdu translation and cross-cultural validation of the Fugl–Meyer assessment in people with stroke. Disabil Rehabil 2022; 44: 8048–8053. 10.1080/09638288.2021.2003449 PubMed DOI
Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000; 25: 3186–3191. 10.1097/00007632-200012150-00014 PubMed DOI
Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract 2011; 17: 268–274. 10.1111/j.1365-2753.2010.01434.x PubMed DOI
Svensson E. Different ranking approaches defining association and agreement measures of paired ordinal data. Stat Med 2012; 31: 3104–3117. 10.1002/sim.5382 PubMed DOI
Svensson E, Holm S. Separation of systematic and random differences in ordinal rating scales. Stat Med 1994; 13: 2437–2453. 10.1002/sim.4780132308 PubMed DOI
Duncan Millar J, van Wijck F, Pollock A, Ali M. Outcome measures in post-stroke arm rehabilitation trials: do existing measures capture outcomes that are important to stroke survivors, carers, and clinicians? Clin Rehabil 2019; 33: 737–749. 10.1177/0269215518823248 PubMed DOI PMC
Kim H, Her J, Ko J, Park DS, Woo JH, You Y, et al. . Reliability, concurrent validity, and responsiveness of the Fugl–Meyer Assessment (FMA) for hemiplegic patients. J Phys Ther Sci 2012; 24: 893–899. 10.1589/jpts.24.893 DOI
Gladstone DJ, Danells CJ, Black SE. The Fugl–Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair 2002; 16: 232–240. 10.1177/154596802401105171 PubMed DOI
Lee HH, Kim DY, Sohn MK, Shin YI, Oh GJ, Lee YS, et al. . Revisiting the proportional recovery model in view of the ceiling effect of Fugl–Meyer Assessment. Stroke 2021; 52: 3167–3175. 10.1161/STROKEAHA.120.032409 PubMed DOI
Hawe RL, Scott SH, Dukelow SP. Taking proportional out of stroke recovery. Stroke 2019; 50: 204–211. 10.1161/STROKEAHA.118.023006 PubMed DOI
Kristersson T, Persson HC, Alt Murphy M. Evaluation of a short assessment for upper extremity activity capacity early after stroke. J Rehabil Med 2019; 51: 257–263. 10.2340/16501977-2534 PubMed DOI
Sullivan KJ, Tilson JK, Cen SY, Rose DK, Hershberg J, Correa A, et al. . Fugl–Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials. Stroke 2011; 42: 427–432. 10.1161/STROKEAHA.110.592766 PubMed DOI
Boyd LA, Hayward KS, Ward NS, Stinear CM, Rosso C, Fisher RJ, et al. . Biomarkers of stroke recovery: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2017; 12: 480–493. 10.1177/1747493017714176 PubMed DOI PMC
Woytowicz EJ, Rietschel JC, Goodman RN, Conroy SS, Sorkin JD, Whitall J, et al. . Determining levels of upper extremity movement impairment by applying a cluster analysis to the Fugl–Meyer Assessment of the upper extremity in chronic stroke. Arch Phys Med Rehabil 2017; 98: 456–462. 10.1016/j.apmr.2016.06.023 PubMed DOI PMC
Huynh BP, DiCarlo JA, Vora I, Ranford J, Gochyyev P, Lin DJ, et al. . Sensitivity to change and responsiveness of the upper extremity Fugl–Meyer assessment in individuals with moderate to severe acute stroke. Neurorehabil Neural Repair 2023; 37: 545–553. 10.1177/15459683231186985 PubMed DOI
Hiragami S, Inoue Y, Harada K. Minimal clinically important difference for the Fugl–Meyer assessment of the upper extremity in convalescent stroke patients with moderate to severe hemiparesis. J Phys Ther Sci 2019; 31: 917–921. 10.1589/jpts.31.917 PubMed DOI PMC
Pandian S, Arya KN, Kumar D. Minimal clinically important difference of the lower-extremity Fugl–Meyer assessment in chronic-stroke. Top Stroke Rehabil 2016; 23: 233–239. 10.1179/1945511915Y.0000000003 PubMed DOI
Prabhakaran S, Zarahn E, Riley C, Speizer A, Chong JY, Lazar RM, et al. . Inter-individual variability in the capacity for motor recovery after ischemic stroke. Neurorehabil Neural Repair 2008; 22: 64–71. 10.1177/1545968307305302 PubMed DOI
Winters C, van Wegen EE, Daffertshofer A, Kwakkel G. Generalizability of the proportional recovery model for the upper extremity after an ischemic stroke. Neurorehabil Neural Repair 2015; 29: 614–622. 10.1177/1545968314562115 PubMed DOI
Smith MC, Byblow WD, Barber PA, Stinear CM. Proportional recovery from lower limb motor impairment after stroke. Stroke 2017; 48: 1400–1403. 10.1161/STROKEAHA.116.016478 PubMed DOI
Ghaziani E, Couppé C, Siersma V, Christensen H, Magnusson SP, Sunnerhagen KS, et al. . Easily conducted tests during the first week post-stroke can aid the prediction of arm functioning at 6 months. Front Neurol 2019; 10: 1371. 10.3389/fneur.2019.01371 PubMed DOI PMC
Hochleitner I, Pellicciari L, Castagnoli C, Paperini A, Politi AM, Campagnini S, et al. . Intra- and inter-rater reliability of the Italian Fugl–Meyer assessment of upper and lower extremity. Disabil Rehabil 2023; 45: 2989–2999. 10.1080/09638288.2022.2114553 PubMed DOI
Wiesner K, Schwarz A, Meya L, Kaufmann JE, Traenka C, Luft AR, et al. . Interrater reliability of the Fugl–Meyer Motor assessment in stroke patients: a quality management project within the ESTREL study. Front Neurol 2024; 15: 1335375. 10.3389/fneur.2024.1335375 PubMed DOI PMC
Prange-Lasonder GB, Alt Murphy M, Lamers I, Hughes AM, Buurke JH, Feys P, et al. . European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus. J NeuroEngineering Rehabil 2021; 18: 162. 10.1186/s12984-021-00951-y PubMed DOI PMC
Van Criekinge T, Heremans C, Burridge J, et al. . Standardized measurement of balance and mobility post-stroke: consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2023; 38: 41–51. 10.1177/15459683231209154 PubMed DOI