Translation, Validity, and Reliability of the Upper Extremity Fugl-Meyer Assessment (FMA-UE) in Persian Speaking Stroke Patients

Objectives: Fugl-Meyer Assessment (FMA) is the common scale for clinical and functional evaluation of sensorimotor conditions and related Upper Extremity (UE) dysfunction after stroke. This study was done to translate and cross-culturally adjust the original upper extremity FMA (FMA-UE) into Persian and to evaluate the psychometric properties of the translated version.  Methods: A procedure of forward/backward translation based on the published guidelines was adopted and two independent bilingual translators performed the translations in each stage. The conceptual and semantic equivalence was obtained through a consensus between experts. Consecutive stroke patients (n=47, male=63%) with a mean age of 61.54±10.9 years were recruited. Content, face, and concurrent validity was calculated using the content validity index, a cognitive interview, and correlation with the Wolf Motor Function Test (WMFT). Internal consistency and intra-rater reliability were determined by calculating Cronbach’s alpha and the Intra-Class Correlation coefficient (ICC2.1). Results: During the forward translation and cultural adjustment, some wording changes were performed. In the forward translation, the most challenging clarifications are related to anatomical terms and positions. The total FMA-Persian score demonstrated acceptable internal consistency (α=0.86) and intra-rater reliability (ICC2.1=0.96). Joint passive motion showed the lowest reliability among all domains. The FMA motor subscales showed a floor effect, while sensation, joint passive motion, and pain domains showed ceiling effects. The correlation between the FMA-UE score and the WMFT was 0.78 (P<0.001).  Discussion: The FMA-UE translation and adjustment were performed successfully into the Persian language. The results of the current study found FMA-UE as an acceptable, reliable, and valid instrument for evaluating the upper limb function after stroke in Persian-speaking patients. However, it should be noted that floor and ceiling effects are respectively present in the domains of the motor subscales and for sensation, passive motion, and pain.