Interpreting Variations in Fugl-Meyer Assessment Protocols: Results and Recommendations from a Nominal Group Consensus Process.

Abstract

Objective: To identify variations among administration and scoring instructions of six upper extremity Fugl-Meyer Assessment (FMA-UE) protocols and to achieve consensus regarding optimal administration procedures.

Design: Nominal group consensus technique comprised of iterative independent reviews of protocol content, anonymous voting, and group consensus meetings.

Setting: Clinicians working in clinical practice and research settings participated in virtual meetings via Zoom.

Participants: Ten experts in stroke rehabilitation and administration of the FMA-UE contributed to the interprofessional consensus group.

Interventions: not applicable.

Main outcome measure: Qualitative reviews of each FMA-UE protocol and rater responses (agree/disagree) regarding variations in general administration instructions (i.e., instructions that could affect the scoring of many individual test items) were discussed and analyzed during a three-phase consensus process. An a priori target of 80% or greater agreement was used to determine group consensus.

Results: Consensus was attained for 7/10 general administration instructions. Recommendations from our consensus group summarize "best practice" general instructions for researchers and clinicians. A case example, in which we found up to a 21-point difference between highest and lowest FMA-UE scores, highlights the potential impact of these protocol variations.

Conclusions: Variations among FMA-UE administration protocols during stroke rehabilitation studies can lead to discrepancies in the interpretation and translation of research findings across institutions and limit the perceived value and uptake of standardized assessments for evidenced-based practice. Results of this nominal group consensus provide a first step toward developing cohesive FMA-UE recommendations for wider dissemination and review.