Abstract
Introduction
There are currently a small number of standardized tools in French that measure and compare the effect of constraint-induced movement therapy, or other recent therapies promoting motor recovery
Objective
To create a French version of the Wolf Motor Function Test (WMFT) and assess its reliability, minimal detectable change, and criterion validity.
Method
Prospective multicenter repeated-measure design with 44 patients with post stroke hemiparesis. A French Version of the WMFT was created; it was then assessed against the Fugl Meyer Assessment-Upper Extremity (French version) to establish its reliability, the minimal detectable change and its validity.
Results
Inter-rater reliability was very good. Reproducibility of the scores was good. Cronbach α coefficients showed adequate internal consistency. The minimal detectable change (MDC 95% ) for functional ability scores was below 10% of the highest possible score; the MDC 95% for performance time was very high at more than 90 seconds. Criterion validity was good.
Conclusion
The French version of the WMFT is reliable and valid. The test shows promise for use as an objective outcome measure for people post stroke in French speaking countries.
Résumé
Introduction
Il n’y a que peu d’instruments de mesure standardisés en langue française évaluant la récupération motrice du membre supérieur parétique suite à une lésion cérébrale vasculaire ou traumatique.
Objectif
Traduire en français le Wolf Motor Function Test (WMFT), puis valider cette version en évaluant sa fiabilité, la différence minimale détectable et sa validité, cela en prenant comme critère externe une version française du Fugl Meyer Assessment (FMA-UE).
Méthode
La traduction et la retro-traduction du WMFT ont été validées par son auteur Steven Wolf. Une étude multicentrique prospective, incluant 44 patients avec une hémiparésie après lésion cérébrale, avec administration à trois reprises du WMFT et du FMA-UE, a été menée.
Résultats
La fiabilité inter-évaluateurs a été très bonne. La reproductibilité des scores a été bonne. Les coefficients de Cronbach α ont démontré une cohérence interne adéquate. La différence minimale détectable (MDC 95 % ) pour les scores de capacité fonctionnelle a été inférieure à 10 % du score le plus élevé possible ; en revanche, la MDC 95 % pour la performance temps a été très élevée, supérieure à 90 secondes. La validité de critère a été bonne.
Conclusion
La version française du WMFT est fiable et valide. Elle devrait permettre une mesure objective de la récupération motrice et fonctionnelle du membre supérieur parétique des patients cérébrolésés des pays francophones.
1
English version
1.1
Introduction
The Wolf Motor Function Test (WMFT) is a commonly used outcome measure for the upper extremity in people post stroke. The WMFT’s psychometric qualities have been extensively examined and has been translated into different languages and is used in over 16 countries . However, the WMFT has not been transposed into French.
The WMFT evaluates movement capability through a series of 15 timed tasks and two strength tasks . Tasks 1 to 6 primarily concern functions assessing the control of the elbow and the shoulder. Task 7 and task 14 evaluate strength. The remaining nine tasks evaluate the functional ability of the arm and hand of the involved upper extremity and are increasingly complex. One task (task 17) (lift basket) is performed in the standing position; the other tasks are performed in the sitting position. Task 16 (fold towel) requires the use of both hands ( Appendix 1 . WMFT, French version).
Every task is given two scores, one for the ability to complete the task (functional ability) and the other for the time used to execute each task (performance time). The entire test takes 30 to 45 minutes to administer. The WMFT can be used in the acute, sub-acute and chronic phases of stroke recovery.
When translating the WMFT into other languages, the Fugl Meyer Assessment, motor subscale for upper extremity (FMA-UE) has served as an external criterion since it is one of the most frequently used outcome measures for motor recovery of the paretic upper extremity . The FMA-UE, available in French , has been used in several studies investigating the criterion validity of the English version of the WMFT .
There are currently a small number of standardized tools in French that measure and compare the effect of constraint-induced movement therapy, or other recent therapies promoting motor recovery . In its guidelines, the French National Authority for Health encouraged researchers to transpose existing scales into French. The aim of the present study was to answer this need by creating and validating a French manual of the WMFT. Thus, the study examined inter-rater reliability, internal consistency, reproducibility of the scores, minimal detectable change as well as criterion validity of a French version of the WMFT.
1.2
Method
1.2.1
Design
This was a multicenter, repeated-measure study, which included a sample of convenience of patients hospitalized at the neurological departments of four clinics in French speaking Western Switzerland. Patients fulfilling inclusion criteria who agreed to participate were included. The WMFT and FMA-UE tests were used three times: the first two sessions took place within two or three consecutive days, while the last one was performed two weeks later. Each testing session consisted of the WMFT and FMA-UE assessment, which were directly performed by one of the three trained evaluators. To avoid therapist-related bias, the order in which therapists evaluated patients was changed from patient to patient. WMFT scoring was performed directly by one therapist, then a second therapist viewed and scored a videotaped version ( Table 1 ). Each WMFT assessment was filmed according to the test protocol. In order to ensure blinding regarding the patient’s test results, the person in charge of the study in each center stored the completed assessments. The scoring of the video took place after a maximum of three days following the direct assessment. The therapists performed the whole assessment in one session in a separate room. They were told not to discuss the performed assessments.
| Testing sessions | |||
|---|---|---|---|
| T1: first session Day 0 | T2: second session 2 to 3 days later | T3: third session 2 weeks later | |
| Scoring of the WMFT and during test administration a | A | C | B |
| Scoring of WMFT by viewing the video b | B | B | C |
| Scoring of the FMA-UE during test administration | A | C | B |
a the first time during test administration;
1.2.2
Study participants
Patients were included if they were over eighteen years-old, French-speaking, and had a paresis of the upper limb due to acute, sub-acute, or chronic cerebral vascular disease or any other cause, for example traumatic or post tumor removal. Stroke was classified as usual: 0 to 2 months: acute, 3 to 12 months: subacute and more than 12 months: chronic stroke.
The patients had to be medically stable and without cognitive deficits that could interfere with their participation in the tests . Patients had to be able to activate the flexors and abductors of the shoulder against gravity, actively extend the wrist, the thumb and two other fingers. They had to be able to sit independently without back or arm support for 5 minutes and to stand, if necessary, with support of a straight cane or quad cane for two minutes .
Reasons for exclusion were: bilateral hemiplegia, another pathology of the central nervous system, and an orthopedic or rheumatologic condition affecting the UE. While initially apraxia and neglect were exclusion criteria, we expanded our criteria to meet enrolment and included patients with these conditions if, according to the opinion of experienced neurological therapists, the use of the paretic upper extremity was not influenced by these syndromes.
The sample size was computed according to the approach proposed by Walter, Eliasziw & Donner . The principle was to be able to achieve a reliability level as close as possible to the original English study which was P = 0.9. We computed the sample size to ensure a reliability ρ ≥ 0.8. The type I and type II errors were fixed respectively to 5% and 20%, and following the recommendation of Walter, Eliasziw & Donner , the minimal required sample size was estimated to be 33 patients. With the inclusion of a 33% reserve to account for potential drop-outs, this led to a projected sample size of 44 patients.
1.2.3
Transcultural adaptation
The translation of the WMFT manual was performed according to international recommendations . A native French-speaking bilingual therapist performed a first translation. A second version of the manual was performed through exchanges with Dr Steven Wolf, the author of the original test. In the next step, three experienced therapists familiar with the WMFT tested the comprehensibility of this second version of the manual with five cognitively intact patients. The text was adapted according to their feedback. A native English-speaking bilingual therapist did not know the WMFT translated back the French version of the manual in English. Dr Steven Wolf checked the back-translation and confirmed its appropriateness in July 2007.
1.2.4
Application of the Wolf Motor Function Test
The WMFT has been administered according to the protocol. Each task has been described and modeled two times; the first demonstration is performed slowly; by this, the patient becomes familiar with the task; and the second is performed more quickly in order to show that the tasks should be performed fast. The patient was not allowed to practice the task before being tested. If objects dropped on the floor, the assessor picked it up or replaced it without interrupting the timing process if the duration of the event did not exceed 5 seconds.
Eventual modifications of the patients’ position have been recorded in order to guarantee identical conditions for each testing session. Each task has been videotaped according to the instructions in the test protocol.
Each task has been timed. The maximum time allowed for each task attempted was 120 seconds. If the patient performed the task incorrectly or was not able to perform it in the maximum time allowed, a 120+ seconds was assigned for the time score.
The functional ability scale ranged from 0 = “Does not attempt with upper extremity (UE) being tested” to 5 = “Does; movement appears to be normal”.
The final functional ability score was the sum score (maximum 75 points); the final time score was the median time required for all timed tasks executed (see detailed description in the French version of the WMFT manual, Appendix 1 ).
1.2.5
Training of the assessors
All sixteen therapists, four from each site, were trained by the investigators. If the therapists were not familiar with the FMA-UE, the investigators trained them accordingly. In addition, the therapists performed both tests among themselves. A meeting followed the training sessions allowing for clarification of uncertainties regarding the test administration, scoring, and material. For the WMFT, the training was considered complete when all assessors in each department achieved an exact agreement for the functional ability scores and independently scored all performance time scores with a maximum difference of 0.20 seconds for each task in the same patient . The FMA-UE training was stopped when the therapists achieved exact agreement on scores in the same patient.
Training of the therapists took about five hours for the WMFT and about two hours for the FMA-UE.
1.2.6
Data collection in the four study centers
Data collection started in June 2008 and was ended in October 2010.
1.2.7
Data analysis
Descriptive statistics were used to describe the sample characteristics, the results of the WMFT and of the FMA-UE. We compared, on each testing occasion, the direct and video scorings of the functional ability ratings and performance time assessments of all participants .
The reproducibility of the scores and inter-rater reliability were computed using intra-class coefficients (ICCs) 1.1 under the assumption of a one-way Anova model, because all therapists did not systematically assess the same patients . There were three testing sessions, two days between the first and second, and two weeks between the second and third. For the estimation of the reproducibility of the scores, we used the data from the second and third testing sessions.
Reliability was considered very good if the ICC was more than 0.90, good if the value was situated between 0.71 and 0.90, moderate if between 0.51 and 0.70 and poor if situated between 0.31 and 0.50 .
Cronbach’s alpha coefficients were used to evaluate the internal consistency of the 15 timed tasks of the WMFT . A total of 12 coefficients were computed: for each testing session (T1, T2, T3) one coefficient for performance time and one for functional ability, once when scoring was performed during test administration, and once when scoring was performed by viewing the video tape. Cronbach’s alpha coefficient was considered as adequate if its value was greater than 0.7 .
We used the reproducibility of the scores data for the calculation of the standard error of measurement (SEM), which led to the definition of the MDC 95% . The MDC at the 95% level (MDC 95% ) and the SEM were computed according to the usual formulas: <SPAN role=presentation tabIndex=0 id=MathJax-Element-1-Frame class=MathJax style="POSITION: relative" data-mathml='MDC95%=1.96⋅SEM⋅2′>MDC95%=1.96⋅SEM⋅2–√MDC95%=1.96⋅SEM⋅2
MDC 95 % = 1.96 ⋅ SEM ⋅ 2
and <SPAN role=presentation tabIndex=0 id=MathJax-Element-2-Frame class=MathJax style="POSITION: relative" data-mathml='SEM=SD⋅(1−ICC)’>SEM=SD⋅(1−ICC)−−−−−−−−√SEM=SD⋅(1−ICC)
SEM = SD ⋅ ( 1 − ICC )
, where SD was the standard deviation of all reproducibility scores .
We tested criterion validity by comparing the association between the performance time scores, the functional ability scores of the WMFT and the scores from the FMA-UE at each testing session. Since the distribution of some of the measures proved to be non-Gaussian according to the Kolmogorov-Smirnov test of normality, we used the non-parametric Spearman correlation coefficient.
SPSS (versions 15 to 19) was used for all statistical computations.
1.3
Results
Forty-eight patients were consented; one dropped out due to acute health problems; 47 patients completed the study. Of these 47 patients, three patients were excluded: one patient for incorrect data and two other patients because of partial data (one task had not been filmed). Therefore, the data analysis was performed on 44 patients.
The majority of the 44 study participants had an acute (56.8%) or subacute (34.1%) stroke; more frequently the affected side was the right (61.4%), the dominant side was affected in 40.9% of the participants and most of them had a moderate (61.4%) or mild (25%) motor paresis ( Table 2 ). The FMA-UE scores determined stroke severity. FMA-UE scores less than 45 points were considered as severe upper limb paresis; FMA-UE scores between 45 and 59 points were considered as moderate upper limb paresis and FMA-UE scores greater than 59 points were considered as mild upper limb paresis.
| Characteristics | n (%) |
|---|---|
| Gender | |
| Women | 13 (29.5) |
| Men | 31 (70.5) |
| Age: mean (SD) [range] | 61.7 (13.6) [18–93] |
| Side of cerebral lesion | |
| Right | 27 (61.4) |
| Left | 17 (38.6) |
| Dominant side affected | 18 (40.9) |
| Time since cerebral lesion: n (%) [mean number of days (SD); range] | |
| Acute (< 60 days) | 25 (56.8) [38 (14); 14–56] |
| Subacute (3 to 9 months) | 15 (34.1) [87 (17); 67–127] |
| Chronic (> 9 months) | 4 (9.1) [1217 (1177); 324–2860] |
| Type of lesion | |
| Ischemia | 33 (75) |
| Hemorrhage | 9 (20.5) |
| Other | 2 (4.5) |
| Impairment severity | |
| Severe motor paresis (total FMA-UE score < 45) | 6 (13.6) |
| Moderate motor paresis (total FMA-UE score 45–59) | 27 (61.4) |
| Discrete motor paresis (total FMA-UE score 60–66) | 11 (25) |
| Hemineglect | 9 (20.5) |
| Physiotherapy a | 42 (95.5) |
| Occupational Therapy a | 43 (97.7) |
a Physiotherapy and occupational therapy treatment, three to five sessions per week, during the study.
The inter-rater reliability of performance time scores and functional ability scores ( Table 3 ) showed a very good ICC 1.1 value (> 0.9; P < 0.001) on the three testing sessions.
| Testing session | Interrater reliability | Internal consistency Cronbach’s alpha coefficient | ||
|---|---|---|---|---|
| ICC 1.1 | 95% confidence interval | Direct scoring | Video | |
| Performance time | ||||
| T1 | 0.999 a | [0.999–1.000] | 0.846 | 0.841 |
| T2 | 0.998 a | [0.996–0.999] | 0.826 | 0.828 |
| T3 | 0.953 a | [0.917–0.974] | 0.856 | 0.817 |
| Functional ability | ||||
| T1 | 0.911 a | [0.843–0.950] | 0.922 | 0.924 |
| T2 | 0.941 a | [0.895–0.967] | 0.939 | 0.931 |
| T3 | 0.922 a | [0.860–0.957] | 0.921 | 0.935 |
All Cronbach’s α coefficients were between 0.817 and 0.939 and showed that the WMFT internal consistency was adequate.
Table 4 summarizes the reproducibility of the scores of the WMFT. Reliability was good; the ICC 1.1 being between 0.849 and 0.907.
| Scoring | ICC 1.1 | CI 95% | SD | SEM | MDC 95 | CI 95% |
|---|---|---|---|---|---|---|
| Performance time | ||||||
| Direct | 0.902 a | [0.829–0.945] | 69.04 | 21.61 | 59.91 | [16.69–103.13] |
| Video | 0.849 a | [0.740–0.914] | 87.03 | 33.82 | 93.74 | [26.10–161.38] |
| Functional ability | ||||||
| Direct | 0.861 a | [0.760–0.921] | 5.21 | 1.94 | 5.38 | [1.50–9.26] |
| Video | 0.907 a | [0.836–0.949] | 4.22 | 1.29 | 3.57 | [0.99–6.15] |
The MDC 95% values were situated between 60 (direct scoring) and 94 seconds (viewing the tape). The corresponding confidence intervals were large. According to the observed MDC 95% values, a patient should improve more than 94 seconds to show a real improvement of the upper limb motor function.
Table 5 describes the criterion validity between the scores of the WMFT and the FMA-UE test.
| Testing session | Scoring | Spearman correlation coefficients | |
|---|---|---|---|
| Functional ability | Performance time | ||
| T1 | Direct | 0.700 a | –0.587 a |
| T1 | Video | 0.519 a | –0.575 a |
| T2 | Direct | 0.770 a | –0.633 a |
| T2 | Video | 0.755 a | –0.604 a |
| T3 | Direct | 0.779 a | –0.571 a |
| T3 | Video | 0.655 a | –0.655 a |
a The P -value was < 0.001for all Spearman’s correlation coefficients.
The negative correlation between the performance time of the WMFT and the FMA-UE was due to the fact that higher FMA-UE scores meant better motor performance, and the need of less time to complete the tasks meant better motor performance for the WMFT. All correlations were significant ( P -value < 0.001).
1.4
Discussion
1.4.1
Comparison between the French version and the original English version
1.4.1.1
Reliability
The French version of the WMFT had a very good inter-rater reliability, good reproducibility of the scores and adequate internal consistency. This corresponds to the original English version . In Morris et al.’s study , inter-rater reliability was 0.97 for performance time and 0.88 for functional ability. As in our study, the ICC values for performance time were slightly better than those for functional ability. Different from Whitall et al. , we did not observe consistently higher reliability when using videotapes. In our study, the ICC was slightly higher for the functional ability scores when viewing the videotape; whereas the ICC was slightly higher for the performance time scores during direct test administration. This observation supports the conclusion by Whitall et al. that test scoring remained reliable and valid, either when performed by direct test administration or by viewing the corresponding tape.
The therapists reported that the test administration was more challenging when directly scored as the assessor had to explain each task, demonstrate it, encourage the patient, manage his/her reaction, determine the functional ability score, measure the time, take notes and manage the camera and the test material. They postulated that their scoring would be more precise when viewing the videotapes. The results of the reproducibility of the scores supported the therapists’ assumption concerning the functional ability scores, as the value of the ICC was slightly higher with videotapes.
The correlation coefficients of the reproducibility of the scores of the French version (ICC 1.1 between 0.849 and 0.907) were slightly smaller compared to those of the English version (0.90 for performance time and 0.95 for functional ability and 0.99 for performance time and 0.97 for functional ability scores ). The slightly lower reliability of the French version could be related to the fact that our study was done in acute and sub-acute periods of the patients’ pathologies, leaving some room for performance evolution. Spontaneous recovery and the fact that these patients continued their rehabilitation programs might have led to improvement of their abilities during this two week time period. On the contrary, reproducibility of the scores of the English version was assessed in the chronic phase of stroke . A further reason could be related to the number of assessors and the assessors’ training. In our study, four centers were involved and sixteen assessors administered the WMFT; consequently different assessors administered the test at different times in the various centres. These circumstances introduced variability and thus decreased the reproducibility of the scores. The assessors were trained by the first author (MPTSc) who visited them at least twice for the training and were available if they needed additional instructions. In Whitall et al.’s study , only two assessors administered the test and judged the videotape and in Morris et al.’s study only three assessors completed the assessments. Based on our experience, the time needed for the training of the WMFT administration should be high – exceeding five hours, and the example used for the training should include a high variety of situations. For example, in our study, discussions during the meetings showed that the therapists encountered uncertainties regarding the use of the score “120+”. Indeed, during the training of the WMFT administration, situations requiring the score “120+” were rare.
1.4.1.2
Minimal detectable change (MDC)
The MDC 95% for functional ability scores viewing videotapes were below 10% of the highest possible score obtained in the test and can be considered as adequate . However, the mean difference was about 1 point higher when scores were given during test administration. Lin et al. found MDC 90% for functional ability scores of 0.37 points and the Excite trial found MDC 95% of 0.1 point. On the contrary, one study , performed in a university hospital in Taiwan with two specifically trained assessors, obtained higher values for the functional ability scores than we obtained when scoring was performed viewing the tape. Their MDC 95% was 12 points for the functional ability scores. Based on their results, the authors criticized the WMFT as insufficiently sensitive to change. This analysis shows that the consideration of the MDC of the WMFT functional ability scale is not unanimous.
The observed MDC 95% value (94 seconds) of performance time scores is much larger than 10% of the 120 seconds allowed for completing the timed tasks and cannot be considered as adequate. It is also much larger than the MDC 90% of 4.36 seconds observed by Lin et al. or the MDC 95% of 0.7 seconds observed by Fritz et al. . According to our results, a real change of the motor performance of a patient required a large improvement of more than 90 seconds. The high amount of change could be due to the score “120+”, which was given when completion of the task required more than 120 seconds or when the patient was unable to perform the task or to perform it correctly. This can be seen in either direct assessment or when viewing videotapes. Six patients received this score during the second testing session, but none on the third one. All the tasks which were assessed at the second testing session with the score “120+” but no longer at the third were the more difficult tasks (e.g. stack checkers, flip cards, lift a pencil) . This evolution can be interpreted as an improvement of the patients’ motor function. One patient’s health condition deteriorated between the second and third testing sessions and this corresponded to two “120+” scores obtained during the third testing session. Unexplainable discordance between the video and direct scoring occurred in only two patients for a total of three tasks. All these discordances could be the reason why the SEM and MDC 95% measures on performance time scores were particularly high in our study.
1.4.1.3
Criterion validity
The French version had a similarly good criterion validity as Wolf et al. when correlated to the FMA-UE scores. The correlation coefficients of the English version were, at the first session, r s = –0.57 ( P = 0.0115) and r s = –0.54 ( P = 0.001), and, at the second session, r s = –0.67 ( P = 0.0015) and r s = –0.68 ( P = 0.001). The time lag between the testing sessions was 12 to 16 days.
1.4.1.4
Limitations of the study
Selection criteria of study participants represent a certain limitation of this research. However, the study’s aim was to compare the French version with the English version and it was necessary to consider the same inclusion criteria as Wolf et al. did in 2001. Another limitation of this research was that the French FMA-UE had not been validated. The decision to choose the FMA-UE as external criterion was pragmatic. First, it is one of the most frequently used instruments to assess UE motor recovery; second, it has been used as the external criterion for several studies investigating the validity of the WMFT; third, there was no other equivalent instrument available in French. It is important to consider that the FMA-UE is a test and not a questionnaire; a questionnaire requires a definite validated translation. We used the French version from Prevost et al. and compared it with the one published by Platz et al. , as well as with the original English version .
Staff and organizational changes in the centers represent potential threats of rigorous test administration. The aim of assessor training was to achieve similar scoring agreement among assessors as Wolf et al. did . Organizational issues and availability of the assessors allowed us to approach this high standard within the time devoted to the training.
The difficulty recruiting patients was another limitation, which prolonged the duration of the study for up to two years and led to changes in the trained assessor teams. This obstruction led to the expansion of the inclusion criteria and included a few subjects with minimal symptoms of neglect or aphasia. Although experienced neurorehabilitation therapists stated the minimal symptoms of neglect or aphasia did not affect their functioning, we do not know if or how these symptoms influenced their participation in the testing sessions.
1.5
Conclusion
In spite of these difficulties, the study resulted in a reliable and valid standardized test manual of the WMFT for French speaking populations. For clinical and research purposes, the availability of a reliable and valid French version of the WMFT will allow for comparing outcomes of interventions aiming at improving the upper extremity motor functions.
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
Appendix 1. Supplementary material: french version of the WMFT manual
Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/j.rehab.2013.03.003 .
2
Version française
2.1
Introduction
Le Wolf Motor Function Test (WMFT) est une mesure de l’issue clinique couramment utilisée pour évaluer la récupération motrice du membre supérieur d’un patient suite à un accident vasculaire cérébral (AVC). Les qualités psychométriques du WMFT ont été examinées de manière extensive . Le test est utilisé dans plus de 16 pays et a été traduit dans différentes langues, mais pas encore en français.
Le WMFT évalue la capacité motrice et fonctionnelle du membre supérieur parétique (MS) par une série de 15 tâches motrices chronométrées et de deux tests de force . Les épreuves 1 à 6 concernent des fonctions examinant essentiellement le contrôle de l’épaule et du coude. L’épreuve 7 et l’épreuve 14 testent la force. Les neuf autres épreuves concernent des activités de manipulation d’objets courants de la vie quotidienne et sont de complexité croissante. À l’exception de l’épreuve 17 (soulever un panier), qui est réalisée en position debout, toutes les épreuves sont réalisées en position assise. L’épreuve 16 (plier une serviette en quatre) nécessite l’utilisation des deux mains. ( Annexe 1 . WMFT, version française).
Chaque tâche est évaluée à l’aide de deux scores, un pour la capacité à accomplir la tâche (capacité fonctionnelle) et un pour le temps utilisé pour accomplir cette même tâche (performance temps). L’administration du test prend environ 30 à 45 minutes.
Le WMFT peut être utilisé dans des phases de récupération aiguë, subaiguë et chronique après lésion cérébrale.
La sous-échelle motrice du membre supérieur du Fugl Meyer Assessment (FMA-UE) est un instrument très fréquemment utilisé pour évaluer la récupération motrice du MS parétique . Le FMA-UE a été utilisé dans plusieurs études investiguant la validité de critère de la version anglaise du WMFT et de versions traduites de cet outil. Le FMA-UE est disponible en français , mais cette traduction n’a pas été validée.
Les thérapeutes ont besoin d’instruments de mesure standardisés et validés en français en particulier pour mesurer et comparer l’effet des thérapies stimulant la récupération motrice. Il existe un grand nombre d’outils d’évaluation provenant essentiellement du monde anglo-saxon mais peu d’entre eux ont cependant été traduits puis validés en langue française . Dans ses lignes directrices cliniques, la Haute Autorité de santé encourage les chercheurs à transposer des instruments de mesure existant dans la langue française. L’étude actuelle a donc visé à combler cette lacune et répondre à cette demande en traduisant en français le WMFT, puis en l’analysant. Ainsi, l’étude a examiné la fiabilité inter-évaluateurs, la cohérence interne, la reproductibilité des scores, la différence minimale détectable ainsi que la validité de critère de cette traduction.
2.2
Méthode et matériel
2.2.1
Type d’étude
Il s’agissait d’une étude multicentrique avec des mesures répétées, portant sur un échantillon de 44 patients hospitalisés dans les services de neurologie de quatre cliniques suisses romandes. Le WMFT et le FMA-UE ont été administrés dans une même session par des évaluateurs formés, et cela à trois reprises : le jour de l’inclusion, deux à trois jours après l’inclusion et deux semaines plus tard. Afin d’éviter un biais lié à l’évaluateur, l’ordre dans lequel les évaluateurs ont appliqué les tests a été changé pour chaque patient. Chaque application du WMFT a été filmée. Les scores du WMFT ont ainsi été donnés immédiatement par le thérapeute administrant le test, puis par un second thérapeute suite au visionnement de l’enregistrement vidéo ( Tableau 1 ). Cette seconde évaluation a été faite dans un délai de trois jours sans échange ni accès au résultat du score donné par le premier thérapeute.
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