Cross-cultural translation and adaptation of the Danish version of the Fugl-Meyer assessment for post stroke sensorimotor function

Abstract

Purpose

The Fugl-Meyer assessment (FMA) is the most widely used and recommended clinical assessment scale for evaluating sensorimotor impairments in stroke patients, but an official Danish version has not been available. This study aimed to perform a standardized translation and cross-cultural adaptation (TCCA) of the FMA into Danish.

Methods

First, a comprehensive eight-step TCCA procedure including forward and backward translation and step-wise reviewing by proof-reader and bilingual physiotherapists, to ensure conceptual and semantic equivalence was applied to develop a Danish version of the FMA. Second, inter-rater reliability of the Danish FMA was assessed in 10 subacute stroke patients. Svensson’s statistical method designed for rank-based paired ordinal data to identify items showing non-systematic or systematic disagreements in relative position or concentration was used to make further improvements on translation.

Results

A Danish FMA version was successfully made by the step-wise TCCA procedure. The clinical validation revealed satisfactory to excellent inter-tester reliability across all items (70–100%). Significant systematic disagreement either in position or concentration or both were observed in about 20% of the items.

Conclusions

The Danish version of the FMA was translated and adapted allowing for a wider standardized use of the FMA in stroke rehabilitation in Denmark.

Implications for rehabilitation

• The Fugl–Meyer assessment (FMA) is the most used and recommended clinical assessment scale for evaluating sensorimotor impairments in stroke patients.

• The translated and adapted Danish version of the FMA is now available for use in research and clinical practice in Denmark.

• This allows for a standardized and unified description of stroke motor recovery and severity in neurorehabilitation nationwide as well as the possibility to compare and conduct trials using FMA internationally.

Keywords:

• Fugl-Meyer’s assessment
• translation and cross-cultural adaptation
• outcome assessment
• upper extremity
• lower extremity
• stroke rehabilitation

Acknowledgements

We also thank the physiotherapists Eva, Merete and Rikke at the Center of Neurorehabilitation, Naestved Hospital, the physiotherapists Christopher and Ruxa at Department of Physiotherapy and Occupational Therapy at Naestved, Slagelse, Ringsted Hospitals, Denmark for their support, Thorbjørn Hein for proofreading, and Julie Kaste Rønnen for assisting whenever assistance was needed. Finally, we gratefully acknowledge the study funders and patients participating, because without their participation this trial would not have been possible.

Disclosure statement

Co-author Søren Thorgaard Skou (STS) reports personal fees outside the submitted work from Journal of Orthopaedic & Sports Physical Therapy, grants from The Lundbeck Foundation, personal fees from Munksgaard and TrustMe-Ed and being co-founder of GLA:D. GLA:D is a non-profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. MAM has nothing to declare. None of the other authors have any conflict of interest.

Additional information

Funding

This work could not have been executed without funding from the Tryg Foundation, the local Naestved, Slagelse and Ringsted Hospitals’ Research Fund and The Regional Research fund of Region Zealand and collaboration with the professional production company, MAYO Production.