title: Rasch analysis staging methodology to classify upper extremity movement impairment after stroke.
abstract: OBJECTIVE
  To define Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) cutoff scores that demarcate 1 level of upper extremity (UE) impairment from another, and describe motor behaviors for each category in terms of expected FMA-UE item performance.
  
  
  METHODS
  Analysis of existing FMA-UE data.
  
  
  METHODS
  University research laboratory.
  
  
  METHODS
  Persons (N=512) 0 to 145 days poststroke, 42 to 90 years of age.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  An item response Rasch analysis staging method was used to calculate cutoff scores, which were defined as the Rasch-Andrich threshold values of 2 criterion FMA-UE items derived from an analysis of this sample. The analysis enabled conversion of cutoff scores, in logit units, to FMA-UE points assessed on 30 FMA-UE voluntary movement items (60 possible points).
  
  
  RESULTS
  The boundary between severe and moderate impairment was defined as -1.59 ± .27 logits or 19 ± 2 points; and between moderate and mild impairment was defined as 2.44 ± .27 logits or 47 ± 2 points. A description of expected performance in each impairment level shows that patients with severe impairment exhibited some distal movements, and patients with mild impairment had difficulties with some proximal movements.
  
  
  CONCLUSIONS
  The cutoff scores, which link to a description of specific movements a patient can, can partially, and cannot perform, may enable formation of heterogeneous patient groups, advance efforts to identify specific movement therapy targets, and define treatment response in terms of specific movement that changed or did not change with therapy.
authors.affiliation: Ralph H. Johnson VA Medical Center, Charleston, SC, USA. WoodbuML@musc.edu
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Woodbury
authors.forename: Craig A
authors.initials: CA
authors.lastname: Velozo
authors.forename: Lorie G
authors.initials: LG
authors.lastname: Richards
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Duncan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D010291:Paresis / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000503:physiopathology*; D034941:Upper Extremity / Q000503:physiopathology*
keywords: FMA-UE; Fugl-Meyer Assessment of the Upper Extremity; IRT; Rehabilitation; Stroke; UE; Upper extremity; item response theory; upper extremity