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Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES)
Availability
Please visit the Shirley Ryan Ability Lab Rehab Measures Database for more information on the MESUPES:
 
Classification
Supplemental: Stroke
Short Description of Instrument
Observer-rated, performance-based assessment of upper extremity function and dexterity. It evaluates the person's ability to control and relax the muscle tone (during passive arm movements), control muscle contractions (during assisted arm movements), and actively move the arm and hand, including adopting proper joint orientation during functional tasks.  
 
Because tone, muscle contractions, and active movements including dexterity, are scored, the scale can be used for patients with stroke with severe to mild motor impairments post-stroke.  
 
This instrument is freely available in 9 languages.
Comments/Special Instructions
Length of test: 5-15 minutes
 
Instructions of the MESUPES are given with the scoring sheet:
 
Scoring and Psychometric Properties
17 items in 3 subsets:
Arm movements (MESUPES arm function; 8 items, scores 0-5
Hand function (MESUPES hand function, 9 items, scores 0-2, including:
- Hand movements: 6 items
- Dexterity/Functional tasks: 3 items
 
The original version of the MESUPES developed by Perfetti (1997, 2001) and Dal Pezzo (1995) comprised 22 items across three categories of (i) arm function (10 items); (ii) hand function (9 items); and (iii) functional tasks (3 items).
 
Rasch Analysis:
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 (Chi square = 3122 DF = 40m p=0.84 for MESUPES arm test and Chi square = 46.21, DF 45, p=0.42 for MESUPES hand test). Test items followed an order of increasing difficulty with no reversed thresholds and no differential item functioning (DIF), meaning that the hierarchy of items from easy to difficult is maintained across sex, age (<60, =60), side of hemiparesis, time since stroke (< 3 months, = 3 months), type of stroke or country (Van de Winckel et al., 2006).
 
Excellent internal consistency:
Person separation index (similar to Cronbach's alpha) = 0.99 for MESUPES arm function
Person separation index = 0.97 for MESUPES hand function
 
Excellent inter-rater reliability:
ICC = 0.95 for MESUPES arm test
ICC = 0.97 for MESUPES hand test
ICC = 0.98 for MESUPES total score
 
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)
weighted percentage agreement = 85.71-98.21 for MESUPES Arm test
(not derived for MESUPES Hand test as 42% of patients scored 0).
 
SEM = 2.2 points for MESUPES arm test
SEM = 0.94 points for MESUPES hand test
SEM = 2.68 points for MESUPES total score
 
MDC = 7 points for MESUPES arm test
MDC = 3 points for MESUPES hand test
MDC = 8 points for MESUPES total score
 
Excellent concurrent validity
Spearman's rho = 0.84 for MESUPES arm test and Modified Motor Assessment Scale (MMAS)
Spearman's rho = 0.80 MESUPES hand test and MMAS
Spearman's rho = 0.87 MESUPES total score and MMAS
 
Excellent convergent validity
r=0.874 MESUPES arm test and Stroke Upper Limb Capacity Scale (SULCS)
r=0.873 MESUPES hand test and SULCS
r=0.914 MESUPES total score and SULCS
 
Floor-ceiling effect:
No floor-or ceiling effect observed for the total test (8/396 or 0.02% have minimum score on MESUPES; 12/396 or 0.03% have maximum total score on MESUPES)
 
Of note: Less than 20% of patients achieved the maximum score (MESUPES arm test), whereas about 42% of patients achieved a score of 0 (MESUPES hand test)
References
Branco JP, Oliveira S, Páscoa Pinheiro J, L Ferreira P. Assessing upper limb function: transcultural adaptation and validation of the Portuguese version of the Stroke Upper Limb Capacity Scale. BMC Sports Sci Med Rehabil. 2017;9:15.
 
Dal Pezzo F, Fioralosso B, Rigodanzo D, Rodighiero L, Solda` M. Cartella valutativa per il recupero dei movimenti della mano nell'emiplegico. In 'Dall' Osservazione all esercizio: la piani?cazione del trattamento riabilitativo' Collana di Riabilitazione direrra da Carlo Perfetti, Aldo Pieroni. Guido Gnocchi Editore srl, Casa editrice Idelson dal 1908; 1995: 7577.
 
Johansson GM, H?ger CK. Measurement properties of the Motor Evaluation Scale for Upper Extremity in Stroke patients (MESUPES). Disabil Rehabil. 2012;34(4):288-294.
 
Perfetti C. Der hemiplegische Patient: Kognitivtherapeutische U ?bungen. P?aum Verlag Physiotherapie, 1997.
Perfetti C. L'exercice the?rapeutique cognitif pour la re?e?ducation du patient he?miple?gique. Masson, 2001.
 
Van de Winckel A, Feys H, van der Knaap S, Messerli R, Baronti F, Lehmann R, Van Hemelrijk B, Pantè F, Perfetti C, De Weerdt W. 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 Rehabil. 2006;20(10):871-884.