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  2. Motor Evaluation Scale for Upper Extremity in Stroke

Motor Evaluation Scale for Upper Extremity in Stroke

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Purpose

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

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instrument details

Acronym MESUPES

Area of Assessment

Dexterity
Range of Motion
Upper Extremity Function

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Stroke Recovery

Populations

Stroke

Key Descriptions

  • 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://www.strokengine.ca/family/mesupes/
  • An instructional video can be found at: https://www.youtube.com/watch?v=m3S2sEMF5jU

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)

Time to Administer

5-15 minutes

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

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly adult

65 +

years

Instrument Reviewers

Initially reviewed by Dr. Ann Van de Winckel, PhD, MSc, PT

Body Part

Upper Extremity

ICF Domain

Body Structure
Body Function
Activity

Measurement Domain

Motor

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.

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Stroke

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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

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 Validity

Portuguese Stroke Patients: (Branco JP, et al., 2017; n=122 Portuguese stroke patients)

  • Excellent convergent validity between MESUPES Hand test and Stroke Upper Limb Capacity Scale (SULCS) (r= 0.873)
  • Excellent convergent validity between MESUPES Arm test and SULCS (r=0.874)
  • Excellent convergent validity between MESUPES Total score and SULCS (r=0.914)

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.

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.

Bibliography

Branco JP, Oliveira S, Páscoa Pinheiro J, L Ferreira P. (2017). "Assessing upper limb function: transcultural adaptation and validation of the Portuguese version of the Stroke Upper Limb Capacity Scale." BMC Sports Sci Med Rehabil, 9(15). Find it on PubMed

Johansson, G.M., Hager, C.K. (2012). "Measurement properties of the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES)." Disabil Rehabil, 34(4):288-294.

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

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