The Effectiveness Evaluation Of Three Assessment Scales For The Upper Extremity Of Stroke Patients

Objective One of the problems in upper limb rehabilitation of stroke patients is the selection of an appropriate assessment scale.The scale is not only of good reliability and validity,but also of great convenience and less time-cost.The scale selected must reflect the upper limb function of stroke patients as comprehensive as possible.There are three assessment scales in this study,including Fugl-Meyer upper extremity assessment(U-FMA),Motor function State Scale(MSS),Functional Test of Hemiplegic Upper Extremity-Hong Kong(FTHUE-HK).In order to test the reliability of these three scales and the standard validity of FTHUE-HK,the scores and time-consuming in the process of using these assessments were compared between groups with different diagnosis,gender and age to provide objective evidences when selecting appropriate assessment for upper limb function of stroke patients.Methods One hundred and two stroke patients onset for the first time in affiliated Zhongda Hospital of Southeast University were accepted in the study.All patients were evaluated by two well-trained occupational therapists using U-FMA,MSS,FTHUE-HK one day before treatment and after treatment.The time-consuming and scores were recorded.The inter-rater reliability of FTHUE-HK was tested by Spearman's rank correlation coefficient.The internal consistency of U-FMA,MSS,FTHUE-HK was tested by Cronback's alpha.The scores and time-consuming of U-FMA and MSS,time-consuming of FTHUE-HK before and after treatment were tested by paired t-test.The results of FTHUE-HK before and after treatment were tested by nonparametric test.The time-consuming of three assessments was tested by ANOVA.There were significant differences in the results and time-consuming between groups of different diagnosis,gender and age.Time-consuming of FTHUE-HK,U-FMA and MSS was tested using ANOVA;Time-consuming of FTHUE-HK,scores and time-consuming of U-FMA and MSS in different diagnosis,gender and age groups were tested by ANOVA.Non parametric test was used to analyze the results of FTHUE-HK in different diagnosis,gender and age groups.Results1?There was high inter-rater reliability of FTHUE-HK(r=1.000).There was high inter consistency of FTHUE-HK,and Cronbach's a was 0.856 before treatment and 0.869 after treatment respectively.2.There was high Cronbach's a in U-FMA and MSS before and after treatment except the reflex parts of U-FMA(Cronbach's a =0.525 before treatment,0.358 after treatment).3?There was high correlation coeffciency between FTHUE-HK and U-FMA(r =0.858 before treatment,0.876 after treatment)as well as FTHUE-HK and MSS(r =0.907 before treatment,0.927 after treatment).4?There were significant differences in the scores and time-consuming of U-FMA?MSS?FTHUE-HK when compared before and after treatment(P<0.05).5?There were significant differences in time-consuming between FTHUE-HK and U-FMA as well as FTHUE-HK and MSS(P<0.05);no significant difference was found between U-FMA and MSS(P>0.05).6?There was no significant difference in wrist isolating movement part of U-FMA when compared before and after treatment in group aging less than 55 years old and group aging more than 65 years old(P>0.05).7?There was no significant difference in FTHUE-HK and U-FMA of different diagnosis,gender and age(P>0.05).8?There was significant difference in hand part of MSS before treatment in different age group(P<0.05)while significant difference was found in wrist part of MSS after treatment in different group(P<0.05).ConclusionsThere was great inter-rater reliability,internal consistency and standard validity of FTHUE-HK;there was great internal consistency of U-FMA and MSS.The scores and time-consuming were different when compared before and after treatment in three assessments.FTHUE-HK was less time-consuming,more convenient and more easily to spread than U-FMA and MSS.There was "floor effect" when using U-FMA,so the first part can't be use alone.There was no difference in using FTHUE-HK and U-FMA between different diagnosis,gender and age.The assessment effectiveness of hand and wrist parts in MSS decreased while age increasing.FTHUE-HK is an appropriate assessment scale when evaluating the upper extremity of stroke patients in clinc.