Date Presented 04/04/19
The Functional Upper-Extremity Levels (FUEL) is an assessment classifying hemiplegic upper-extremity (UE) function. It provides “common language” to facilitate interdisciplinary communication of UE function. It is used to guide goal writing and UE treatment progression. This research supports a strong correlation to the Fugl-Meyer, the gold standard UE assessment poststroke. An advantage of the FUEL is that it assesses the hemiplegic UE during functional activities of daily living.
Primary Author and Speaker: Rachel Feld-Glazman
Additional Authors and Speakers: Lisa Spinelli, Ashley Foley, Daniel Geller, Steve Van Lew, Adrienne Dicembri, Nettie Capasso
PURPOSE: The Upper Extremity (UE) Fugl-Meyer (UE-FM) is considered the gold standard for measuring UE impairment in post-stroke research; however, one major limitation is its inability to measure UE performance during Activities Daily Living (ADL). The FUEL (Functional Upper Extremity Level) is a classification system, which can be used during ADL to evaluate and classify UE performance (and motor recovery) in stroke individuals. The objective of this study was to correlate the levels of the FUEL with the UE-FM.
LEVEL OF RESEARCH: The participant will require knowledge of clinical practice for patients post stroke, neurological UE assessments, and validity statistics. This level of knowledge is considered intermediate.
DESIGN: Retrospective analysis for performance improvement.
SETTING: Acute inpatient rehabilitation patients on a stroke unit.
PARTICIPANTS: 107 patients post stroke
MAIN OUTCOME MEASURES: The UE-FM, a standardized objective measure, was used to assess UE motor function, while the FUEL, a reliable measure, was used to assess UE functional performance. Both were administered at admission and discharge for post-stroke individuals and a Pearson's Correlation was performed.
RESULTS: A positive Pearson Coefficient demonstrated a correlation between the UE-FM and the FUEL scores for both admission (r=0.932, p=0.002) an discharge (r=0.911, p=0.000). Linear regression results demonstrated a (df=1, F=697.25, p=0.000) indicating a predictive value for both tools when used simultaneously. Correlation results for UE-FM and FUEL admission and discharge scores support levels of criterion validity for the FUEL.
CONCLUSIONS: Analysis shows the FUEL classification levels consistently reflect progress on Fugl-Myer scoring. Use of the FUEL has the potential to provide a more functional illustration of UE recovery post stroke when compared to the Fugl-Meyer. FUEL functional information can assist with interdisciplinary communication, treatment planning, and goal setting.
References
Sullivan, K. J., Tilson, J, K., Cen, S. Y., Rose, D. K., Hershberg, J., Correa, A.,…Duncan, P. W. (2011). Fugl-Meyer assessment of sensorimotor function after stroke: Standardized training procedure for clinical practice and clinical trials. Stroke, 42(2), 427-432. doi:10.1161/STROKEAHA.110.592766
Van Lew, S., Gellar, D., Feld-Glazman, R., Capasso, N., Dicembri, A., & Pinto Zipp, G. (2015). Development and Preliminary Reliability of the Functional Upper Extremity Levels (FUEL). American Journal of Occupational Therapy, 69, 6906350010p1-6906350010p5. doi:10.5014/ajot.2015.016006
