Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES)

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the MESUPES. Two English studies were identified.

Floor and ceiling effect

No studies have reported on the floor or ceiling effects of the MESUPES.

Van de Winckel (personal correspondence, 2015) noted that in the study by Van de Winckel et al. (2006) in which 396 patients with low to high motor performance following stroke were assessed using the MESUPES less than 5% of patients achieved a score of 0 on the arm items and less than 20% of participants achieved the maximum score. Approximately 42% of participants achieved a score of 0 on the hand items and less than 5% of patients achieved a maximum score on the hand items.

Reliability

Internal consistency
Van de Winckel et al. (2006) examined internal consistency of the MESUPES in a sample of patients with stroke using Principal Component Analysis and Rasch analysis. Rasch analysis was used to determine ‘item-trait interaction’, which shows the degree of invariance across the intended dimension, and ‘person separation index’. Internal consistency was obtained when the MESUPES was divided into the MESUPES-Arm (8 items) and MESUPES-Hand (9 items) subtests. Rasch analysis and fit statistics showed that both subtests adhered to unidimensional characteristics, whereby all items in the subtests pertain to the same construct. The person separation index was 0.99 for the MESUPES-Arm and 0.97 for the MESUPES-Hand, indicating very high internal consistency.

Inter-rater
Van de Winckel et al. (2006) investigated inter-rater reliability of the MESUPES in a sample of 56 patients with subacute to chronic stroke. Assessments were conducted by 2 assessors over 24 hours. Inter-rater reliability, calculated using intra-class correlation coefficients (ICCs) was excellent for the arm function total score (ICC=0.95, 95% CI 0.91-0.97) and hand function total score (ICC=0.97, 95% CI 0.95-0.98). Assessment of inter-rater reliability by weighted percentage agreement and weighted kappa confirmed item reliability for the arm function subtest (weighted kappa coefficient = 0.62-0.79; weighted percentage agreement 85.71-98.21); scores were not derived for hand function items as more than 50% of the sample scored 0.
Johansson & Hager (2012) investigated inter-rater reliability of the MESUPES in a sample of 42 patients with subacute to chronic stroke. Assessments were conducted by 2 therapists within 48 hours. Inter-rater reliability, calculated by percentage agreement using linear-weighted kappa analysis revealed good to very good agreement between raters (kappa range 0.63-0.96). Relative and absolute reliability was measured using intra-class correlation coefficients (ICCs) and standard error of measurement (SEM): item reliability was moderate to very high (ICC=0.63-0.96); reliability of subscores and the total score was very high (ICC=0.98, 95% CI 0.96=0.99); and the total score demonstrated sufficient absolute reliability (SEM=2.68).

Intra-rater
No studies have reported on the intra-rater reliability of the MESUPES.

Test-retest
See inter-rater reliability above for results also pertaining to test-retest reliability. 

Validity

Content
The original version of the MESUPES developed by Perfetti & Dal Pezzo comprised 22 items across three categories of (i) arm function (10 items); (ii) hand function (9 items); and (iii) functional tasks (3 items).

Van de Winckel et al. (2006) investigated validity and unidimensionality of the MESUPES in a sample of 396 patients with subacute to chronic stroke. Principle Component Analysis (PCA) of the original 22-item version revealed two dimensions: arm function and hand function. Rasch analysis of these two separate scales identified misfit among five items (respectively 2 arm items and 3 hand items). Following removal of these items, subsequent Rasch analysis of the remaining 17 items and fit statistics confirmed unidimensionality of both arm and hand scales:

 

Person fit

Item fit

Person separation index

Arm function

-0.51±1.19

-0.65±1.07

0.99

Hand function

-0.12±0.71

0.15±1.21

0.97

Test items followed an order of increasing difficulty with no reversed thresholds and no differential item functioning (DIF) according to gender, age (<60, ≥60), side of hemiparesis, time since stroke (< 3 months, ≥ 3 months), type of stroke or country (Van de Winckel et al., 2006).

Criterion
Predictive
No studies have reported on the predictive validity of the MESUPES.

Concurrent
Johansson & Hager (2012) investigated concurrent validity of the MESUPES in a sample of 42 patients with subacute to chronic stroke by comparison with the Modified Motor Assessment Scale (MMAS), using Spearman’s rho. Correlations were high between the MESUPES total scores and the MMAS (r=0.87); MESUPES arm items and MMAS (r=0.84); and MESUPES hand items and MMAS (r=0.80).

Construct
Known Group Validity
No studies have reported on the known group validity of the MESUPES.

Convergent/Discriminant Validity
No studies have reported on convergent/discriminant validity of the MESUPES.

Responsiveness

Johansson & Hager (2012) assessed minimal detectable change (MDC) of the MESUPES with a sample of 42 patients with subacute to chronic stroke. Patients were assessed at two time points 48 hours apart. The authors reported change scores of 8, 7 and 5 (95%, 90% and 80% confidence intervals, respectively) were required for certainty of true change.

 Sensitivity & Specificity
No studies have reported on sensitivity/specificity of the MESUPES.

References

Johansson, G.M. & Hager, C.K. (2012). Measurement properties of the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES). Disability & Rehabilitation, 34(4):288-94. DOI: 10.3109/09638288.2011.606343

 Van de Winckel, A., Feys, H., van der Knaap, S., Messerli, R., Baronti, F., Lehmann, R., Van Hemelrijk, B., Pante, F., Perfetti, C., & De Weerdt, W. (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). Clinical Rehabilitation, 20, 871-84.