Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Credentialing Assessors in the Fugl Meyer Assessment and Implications for Stroke Recovery Trials: Experience from the AVERT-DOSE Trial. (#145)

Kate Hayward 1 , Fiona Ellery 2 , Sarah Newton 2 3 4 , Gemma Hughes 5 , Joanne Quek 3 , Julie Bernhardt 2 , On behalf of the AVERT-DOSE trial collaboration 2
  1. Physiotherapy, Medicine, and Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
  2. Stroke Theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
  3. Physiotherapy, University of Melbourne, Parkville, VIC, Australia
  4. Occupational Therapy, Austin Health, Heidelberg, VIC, Australia
  5. Physiotherapy, Austin Health , Heidelberg, VIC, Australia

Background: Fugl Meyer Assessment (FMA) was a recommended core outcome by the Stroke Recovery and Rehabilitation Roundtable. A credentialing plan is part of assessment fidelity, which ensures an outcome is performed accurately and consistently. Yet, credentialing is rarely implemented in stroke recovery trials. An accessible approach to FMA credentialing would add to current acute stroke outcomes that require credentialing e.g., National Institutes of Health Stroke Scale and modified Rankin Scale.

Aim: To develop a standardised approach for FMA credentialing.

Methods: A set of training materials (manual/scoring sheets/instructional video/patient videos for scoring) were developed and implemented within AVERT-DOSE trial assessor training. Assessors scored two patient videos that were externally rated as pass (greater than or equal to 90%) or fail (less than 90%). Failure necessitated one of two pathways: a) moderate score (70-89%) warranted a consultation between the assessor and an expert FMA assessor or b) low score (less than 70%) necessitated re-rating of the videos. Assessors provided feedback on the approach and materials, which informed amendments executed. 

Results: 258 assessors from seven countries completed FMA credentialing. Round-1 videos were rated by 217 assessors: 57 (26%) passed and 160 (74%) failed: 110 warranted a one-on-one consult, and 50 necessitated re-rating. Feedback during Round-1 indicated that assessors wanted additional planes of movement to be viewable. As such, Round-2 videos were created and implemented with 41 assessors: 14 (34%) passed and 27 (66%) failed: 26 warranted a one-on-one consult and 1 necessitated re-rating.

Conclusion: Implementing credentialing for FMA identified many assessors that required additional training, even with improved videos that included multiple planes of movement. As such, we recommend that all stroke recovery trials include a credentialing process to ensure assessors are competent to accurately complete assessment. Our developed approach, including training materials, are available for use by the stroke recovery research community.