Motor Evaluation Scale for Upper Extremity in Stroke

Link to instrument: Link On Stroke Engine

Acronym:

MESUPES

Purpose:

A 17-item objective evaluation scale designed to assess quality of movement of arm and hand function after stroke

Description:

The scale consists of 17 items into two subscales:
MESUPES-Arm function: 8 items (scores 0-5)
MESUPES-Hand function: 9 items (scores 0-2)

During the MESUPES-Arm function, the movements are scored in three consecutive phases:

1. The task is performed passively and tone is evaluated (0-1)
2. The therapist performs the movement while the patients assists and the presence of normal muscle contractions is scored (2)
3. The patient performs the movement by him/herself and the range of motion that is executed in a qualitatively normal way is scored (3-5)

The first four items are performed in supine; all other items are performed in a sitting position with hips and knees in 90° flexion and elbows on the table. The patient cannot be assessed if he/she cannot maintain an upright position for the tasks in sitting position.

The therapist should wait until tone is normalized before starting a new task. If the patient is not able to achieve a relaxed starting position, he/she is awarded a score of 0 for the item.

The MESUPES-Hand function is divided in two parts:

1. Patients are instructed to perform specific active hand or finger movements and patients are scored for correctly executed range of motion (0-2) (6 items)
2. Patients are instructed to perform functional tasks and the correct orientation of hand and fingers during the performance is scored (0-2) (3 items)

Range = 0-58; Item scores are summed (Total score /58; MESUPES-Arm test /40; MESUPES-Hand test /18)

Instructions can be found in Van de Winckel et al., 2006, and on http://ift.tt/28nJD3i

Area of Assessment: Dexterity, Range of Motion, Upper Extremity Function

Body Part: Upper Extremity

ICF Domain: Body Structure, Body Function, Activity

Domain: Motor

Assessment Type: Performance Measure

Length of Test: 06 to 30 Minutes

Time to Administer:

10 minutes (range 5-15 min)
5 min for patients with very poor or very good motor function
15 min for patients with more severe hypertonia

Number of Items: 17

Equipment Required:

• Plinth or mat
• Desk and chair (patient is sitting with hip and knees in 90° flexion)
• Ruler or wooden block marked with 1 cm and 2 cm to measure range of movement during hand tasks
• Plastic bottle (cylinder, diameter 2.5 cm, height 8 cm; 20 fl oz or 591 ml soda or water bottle)
• Dice (1.5 cm x 1.5 cm)
• Smaller plastic bottle (such as a wipe out/correction fluid bottle: cylinder, diameter 2.5 cm, height 8 cm)

Training Required:

Instructions are provided with the assessment sheet in Van de Winckel et al. (2006) and on http://ift.tt/28nJD3i . Instructions are self-explanatory for trained clinicians in stroke rehabilitation. A tutorial video is in the making. Questions on the use of the MESUPES can be addressed to Dr. Ann Van de Winckel (avandewi@umn.edu).

Type of training required: No Training

Cost: Free

Actual Cost: Cost of equipment.

Age Range: Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Stroke

Populations Tested: Adults with stroke

Standard Error of Measurement (SEM):

Subacute to Chronic Stroke: (Johansson & Hager, 2011; n= 42; mean age = 56 (12) years; mean time post stroke = 7 months (range 3 - 15.3 months).

• SEM for Arm test (/40) = 2.2 points
• SEM for Hand test (/18) = 0.94 points
• SEM for Total score (/ 58) = 2.68 points

Minimal Detectable Change (MDC):

Subacute to Chronic Stroke: (Johansson & Hager, 2011; n= 42; mean age = 56 (12) years; mean time post stroke = 7 months (range 3 - 15.3 months).

• MDC for Arm test (/40) = 6.10 = 7 points
• MDC for Hand test (/18) = 2.61 = 3 points
• MDC for Total score (/58) = 7.43 = 8 points

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Not a diagnostic test

Normative Data:

Not Established

Test-retest Reliability:

Not Established

Interrater/Intrarater Reliability:

Subacute to Chronic Stroke: (Johansson & Hager, 2011; n= 42; mean age = 56 (12) years; mean time post stroke = 7 months (range 3 - 15.3 months) and Van de Winckel et al., 2006, n = 56.)

• Excellent inter-rater reliability for Arm test (ICC = .95)
• Excellent inter-rater reliability for Hand test (ICC = .97)
• Excellent inter-rater reliability for Total score (ICC = .98)
• Good to very good inter-rater reliability with weighted kappa coefficient = 0.62-0.79 (Van de Winckel et al., 2006); weighted kappa coefficient = 0.63-0.96 (Johansson & Hager, 2012);
• Good to very good inter-rater reliability with weighted percentage agreement 85.71-98.21; Scores were not derived for hand function items as 42% of the sample scored 0 (Van de Winckel et al., 2006).

Internal Consistency:

Subacute to Chronic Stroke: (Van de Winckel et al., 2006, n = 56)

• Excellent internal consistency for Arm test (person separation index in Rasch analysis, measurement for internal consistency comparable to Chronbach's alpha = 0.99)
• Excellent internal consistency for Hand test (person separation index = 0.97)

Criterion Validity (Predictive/Concurrent):

Concurrent validity: Subacute to Chronic Stroke: (Johansson & Hager, 2012, n = 42)

• Excellent concurrent validity between MESUPES Arm test and Modified Motor Assessment Scale (MMAS) (Spearman's rho = 0.84)
• Excellent concurrent validity between MESUPES Hand test and MMAS (r = 0.80)
• Excellent concurrent validity between MESUPES Total score and MMAS (r = 0.87)

Construct Validity (Convergent/Discriminant):

Not Established

Content Validity:

Subacute to Chronic Stroke: (Van de Winckel et al., 2006, n = 396)

• Excellent content validity (unidimensionality of Arm test and Hand test): Rasch analysis was performed on the original scale of 22 items (Perfetti & Dal Pezzo, 1995). Five items were removed and the arm scale and hand scale were assessed separately. Rasch analysis of the remaining 8 arm items and 9 hand items and their fit statistics (i.e. χ2 comparing observed scores with a predicted model) confirmed unidimensionality of both arm (χ2 = 31.22, DF = 40, p = 0.84) and hand scales (χ2 = 46.21, DF = 45, p = 0.42).
• Excellent internal consistency across subgroups of patients with stroke: Van de Winckel et al. (2006) demonstrated that the hierarchy of the items (from easy to difficult) is maintained across subgroups of adults with stroke: gender; age.

Face Validity:

Not Established

Floor/Ceiling Effects:

Subacute to Chronic Stroke: (Van de Winckel et al., 2006, n = 396)

• Excellent: No floor- or ceiling effect observed for the Total test (min score of 0 on Total score = 8/396 or 0.02%) (max score of 58 on Total score = 12/396 or 0.03%)
• Of note: The data on 396 patients with subacute to chronic stroke demonstrated that 163/396 (42%) do not recover hand function after stroke and therefore had a score of 0 on the hand items, whereas only 76/396 (19%) achieved a maximum score on the arm items.

Responsiveness:

Not Established

Considerations:

Because, tone, muscle contractions and active movements are scored, the scale can be used for patients with stroke with a wide range of motor impairments: from no active arm and hand function to minimal motor impairments.

Bibliography:

Johansson, G.M., Hager, C.K. (2011). "Measurement properties of the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES)." Disabil Rehabil, 34(4):288-294.Find it on PubMed

Van de Winckel, A., et al. (2006). "Can quality of movement be measured? Rasch analysis and inter-rater reliability of the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES)." Clin Rehab, 20(10): 871-884. Find it on PubMed

Year published: 2006

Instrument in PDF Format: Yes

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