# Standardized International Manual of the Fugl-Meyer Assessment of Motor Function After Stroke

## TL;DR

This paper creates a standardized international manual for the Fugl-Meyer Assessment to improve consistency and reliability in stroke rehabilitation evaluations.

## Contribution

The paper introduces a consensus-based international manual for the Fugl-Meyer Assessment aligned with the original assessment and includes training recommendations for assessors.

## Key findings

- A consensus-based manual was developed with over 79% agreement on each section.
- Structured training is recommended for novice assessors to ensure consistent scoring.
- The original FMA assessment shows strong validity and reliability but lacks data on minimal clinically important difference thresholds.

## Abstract

Fugl-Meyer Assessment of upper and lower extremity is the recommended primary clinical outcome measure of motor function in stroke rehabilitation. However, variations between different manuals undermine the reliability of the assessment, making it difficult to compare results and pool data across trials and centers.

To develop a consensus-based international Fugl-Meyer Assessment (FMA) manual aligned with the original assessment along with agreed recommendations for assessor training. Additionally, the study aims to provide a critical review of current evidence on the measurement properties.

Fourteen experienced health professionals and expert FMA users, working in 3 different continents, 6 countries and 13 research centers, participated in an iterative consensus process to generate a comprehensive agreed FMA manual. Agreement of at least 75% determined by voting was the minimum accepted threshold for each section of the manual. Consensus on assessor training was also sought. The evidence on measurement properties was compiled through a systematic literature review.

Greater than 79% agreement was reached for each section of the final FMA manual. Assessors should have strong foundation in neurorehabilitation and clinical assessment. Novice assessors should undergo structured training including supervised practical training with patients to ensure consistent and accurate scoring. Previous research adherent to the original FMA assessment, confirms strong validity and reliability, but provide limited information of minimal clinically important difference thresholds.

This internationally agreed manual provides a common ground for improved consistency in administration of FMA worldwide and thereby will enable reliable data pooling and increase the comparability of results in future trials and clinical practice.