Dimensionality and Item-Difficulty Hierarchy of the Lower Extremity Fugl-Meyer Assessment in Individuals with Subacute and Chronic Stroke Presented in part as a poster to the American Congress of Rehabilitation Medicine, November 13, 2013, Orlando, FL.

Chitralakshmi K. Balasubramanian, Chih-ying Li, Mark G. Bowden, Pamela W. Duncan, Steven A. Kautz, Craig A. Velozo

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective To investigate the dimensionality and item-difficulty hierarchy of the Fugl-Meyer Assessment of the lower extremity (FMA-LE). Design Secondary analyses of data pooled from 4 existing datasets: a phase III randomized controlled trial investigating the effectiveness of body weight support and a treadmill for rehabilitation of walking poststroke, and 3 cross-sectional studies investigating the link between impaired motor performance poststroke and walking. Setting University research centers and rehabilitation centers. Participants A pooled sample of individuals with a stroke (N=535, men=313; mean age ± SD, 61.91±12.42y). Interventions Not applicable. Main Outcome Measures Confirmatory factor analyses (CFA) and Rasch residual principal component analysis (PCA) investigated the dimensionality of the FMA-LE. The Rasch analysis rating scale model investigated item-difficulty hierarchy of the FMA-LE. Results The CFA showed adequate fit of a 3-factor model, with 2 out of 3 indices (CFA=.95; Tucker-Lewis Index=.94; root mean square error of approximation=.124) showing good model fit. Rasch PCA showed that removal of the reflex and coordination items explained 90.8% of variance in the data, suggesting that the abnormal synergy items contributed to the measurement of a unidimensional construct. However, rating scale model results revealed deviations in the item-difficulty hierarchy of the unidimensional abnormal synergy items from the originally proposed stepwise sequence of motor recovery. Conclusions Our findings suggest that the FMA-LE might represent a multidimensional construct, challenging the use of a total score of the FMA-LE to predict lower extremity motor recovery. Removal of the misfit items resulted in creation of a unidimensional scale composed of the abnormal synergy items. However, this unidimensional scale deviates from the originally proposed hierarchical ordering.

Original languageEnglish (US)
Pages (from-to)582-589
Number of pages8
JournalArchives of Physical Medicine and Rehabilitation
Volume97
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

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Posters
Lower Extremity
Rehabilitation
Stroke
Medicine
Statistical Factor Analysis
Principal Component Analysis
Walking
Rehabilitation Centers
Reflex
Randomized Controlled Trials
Cross-Sectional Studies
Body Weight
Outcome Assessment (Health Care)
Research

Keywords

  • Lower extremity
  • Rehabilitation
  • Stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

@article{0c01ddeddbe3490ba6072776e097dbb5,
title = "Dimensionality and Item-Difficulty Hierarchy of the Lower Extremity Fugl-Meyer Assessment in Individuals with Subacute and Chronic Stroke Presented in part as a poster to the American Congress of Rehabilitation Medicine, November 13, 2013, Orlando, FL.",
abstract = "Objective To investigate the dimensionality and item-difficulty hierarchy of the Fugl-Meyer Assessment of the lower extremity (FMA-LE). Design Secondary analyses of data pooled from 4 existing datasets: a phase III randomized controlled trial investigating the effectiveness of body weight support and a treadmill for rehabilitation of walking poststroke, and 3 cross-sectional studies investigating the link between impaired motor performance poststroke and walking. Setting University research centers and rehabilitation centers. Participants A pooled sample of individuals with a stroke (N=535, men=313; mean age ± SD, 61.91±12.42y). Interventions Not applicable. Main Outcome Measures Confirmatory factor analyses (CFA) and Rasch residual principal component analysis (PCA) investigated the dimensionality of the FMA-LE. The Rasch analysis rating scale model investigated item-difficulty hierarchy of the FMA-LE. Results The CFA showed adequate fit of a 3-factor model, with 2 out of 3 indices (CFA=.95; Tucker-Lewis Index=.94; root mean square error of approximation=.124) showing good model fit. Rasch PCA showed that removal of the reflex and coordination items explained 90.8{\%} of variance in the data, suggesting that the abnormal synergy items contributed to the measurement of a unidimensional construct. However, rating scale model results revealed deviations in the item-difficulty hierarchy of the unidimensional abnormal synergy items from the originally proposed stepwise sequence of motor recovery. Conclusions Our findings suggest that the FMA-LE might represent a multidimensional construct, challenging the use of a total score of the FMA-LE to predict lower extremity motor recovery. Removal of the misfit items resulted in creation of a unidimensional scale composed of the abnormal synergy items. However, this unidimensional scale deviates from the originally proposed hierarchical ordering.",
keywords = "Lower extremity, Rehabilitation, Stroke",
author = "Balasubramanian, {Chitralakshmi K.} and Chih-ying Li and Bowden, {Mark G.} and Duncan, {Pamela W.} and Kautz, {Steven A.} and Velozo, {Craig A.}",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.apmr.2015.12.012",
language = "English (US)",
volume = "97",
pages = "582--589",
journal = "Archives of Physical Medicine and Rehabilitation",
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TY - JOUR

T1 - Dimensionality and Item-Difficulty Hierarchy of the Lower Extremity Fugl-Meyer Assessment in Individuals with Subacute and Chronic Stroke Presented in part as a poster to the American Congress of Rehabilitation Medicine, November 13, 2013, Orlando, FL.

AU - Balasubramanian, Chitralakshmi K.

AU - Li, Chih-ying

AU - Bowden, Mark G.

AU - Duncan, Pamela W.

AU - Kautz, Steven A.

AU - Velozo, Craig A.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objective To investigate the dimensionality and item-difficulty hierarchy of the Fugl-Meyer Assessment of the lower extremity (FMA-LE). Design Secondary analyses of data pooled from 4 existing datasets: a phase III randomized controlled trial investigating the effectiveness of body weight support and a treadmill for rehabilitation of walking poststroke, and 3 cross-sectional studies investigating the link between impaired motor performance poststroke and walking. Setting University research centers and rehabilitation centers. Participants A pooled sample of individuals with a stroke (N=535, men=313; mean age ± SD, 61.91±12.42y). Interventions Not applicable. Main Outcome Measures Confirmatory factor analyses (CFA) and Rasch residual principal component analysis (PCA) investigated the dimensionality of the FMA-LE. The Rasch analysis rating scale model investigated item-difficulty hierarchy of the FMA-LE. Results The CFA showed adequate fit of a 3-factor model, with 2 out of 3 indices (CFA=.95; Tucker-Lewis Index=.94; root mean square error of approximation=.124) showing good model fit. Rasch PCA showed that removal of the reflex and coordination items explained 90.8% of variance in the data, suggesting that the abnormal synergy items contributed to the measurement of a unidimensional construct. However, rating scale model results revealed deviations in the item-difficulty hierarchy of the unidimensional abnormal synergy items from the originally proposed stepwise sequence of motor recovery. Conclusions Our findings suggest that the FMA-LE might represent a multidimensional construct, challenging the use of a total score of the FMA-LE to predict lower extremity motor recovery. Removal of the misfit items resulted in creation of a unidimensional scale composed of the abnormal synergy items. However, this unidimensional scale deviates from the originally proposed hierarchical ordering.

AB - Objective To investigate the dimensionality and item-difficulty hierarchy of the Fugl-Meyer Assessment of the lower extremity (FMA-LE). Design Secondary analyses of data pooled from 4 existing datasets: a phase III randomized controlled trial investigating the effectiveness of body weight support and a treadmill for rehabilitation of walking poststroke, and 3 cross-sectional studies investigating the link between impaired motor performance poststroke and walking. Setting University research centers and rehabilitation centers. Participants A pooled sample of individuals with a stroke (N=535, men=313; mean age ± SD, 61.91±12.42y). Interventions Not applicable. Main Outcome Measures Confirmatory factor analyses (CFA) and Rasch residual principal component analysis (PCA) investigated the dimensionality of the FMA-LE. The Rasch analysis rating scale model investigated item-difficulty hierarchy of the FMA-LE. Results The CFA showed adequate fit of a 3-factor model, with 2 out of 3 indices (CFA=.95; Tucker-Lewis Index=.94; root mean square error of approximation=.124) showing good model fit. Rasch PCA showed that removal of the reflex and coordination items explained 90.8% of variance in the data, suggesting that the abnormal synergy items contributed to the measurement of a unidimensional construct. However, rating scale model results revealed deviations in the item-difficulty hierarchy of the unidimensional abnormal synergy items from the originally proposed stepwise sequence of motor recovery. Conclusions Our findings suggest that the FMA-LE might represent a multidimensional construct, challenging the use of a total score of the FMA-LE to predict lower extremity motor recovery. Removal of the misfit items resulted in creation of a unidimensional scale composed of the abnormal synergy items. However, this unidimensional scale deviates from the originally proposed hierarchical ordering.

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