Abstract
BackgroundTechnology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabilitation of neurological conditions, but use in clinical practice remains limited. Agreement on a core set of reliable, valid and accessible outcome measures to assess rehabilitation outcomes is needed to generate strong evidence about effectiveness of rehabilitation approaches, including technologies. This paper collates and synthesizes a core set from multiple sources; combining existing evidence, clinical practice guidelines and expert consensus into European recommendations for Clinical Assessment of Upper Limb In Neurorehabilitation (CAULIN).MethodsData from systematic reviews, clinical practice guidelines and expert consensus (Delphi methodology) were systematically extracted and synthesized using strength of evidence rating criteria, in addition to recommendations on assessment procedures. Three sets were defined: a core set: strong evidence for validity, reliability, responsiveness and clinical utility AND recommended by at least two sources; an extended set: strong evidence OR recommended by at least two sources and a supplementary set: some evidence OR recommended by at least one of the sources.ResultsIn total, 12 measures (with primary focus on stroke) were included, encompassing body function and activity level of the International Classification of Functioning and Health. The core set recommended for clinical practice and research: Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT); the extended set recommended for clinical practice and/or clinical research: kinematic measures, Box and Block Test (BBT), Chedoke Arm Hand Activity Inventory (CAHAI), Wolf Motor Function Test (WMFT), Nine Hole Peg Test (NHPT) and ABILHAND; the supplementary set recommended for research or specific occasions: Motricity Index (MI); Chedoke-McMaster Stroke Assessment (CMSA), Stroke Rehabilitation Assessment Movement (STREAM), Frenchay Arm Test (FAT), Motor Assessment Scale (MAS) and body-worn movement sensors. Assessments should be conducted at pre-defined regular intervals by trained personnel. Global measures should be applied within 24 h of hospital admission and upper limb specific measures within 1 week.ConclusionsThe CAULIN recommendations for outcome measures and assessment procedures provide a clear, simple, evidence-based three-level structure for upper limb assessment in neurological rehabilitation. Widespread adoption and sustained use will improve quality of clinical practice and facilitate meta-analysis, critical for the advancement of technology-supported neurorehabilitation.
Highlights
Technology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabili‐ tation of neurological conditions, but use in clinical practice remains limited
Global measures should be applied within 24 h of hospital admission and upper limb specific measures within 1 week
Recommended outcome measures (OM) to assess at activity level add four capacity measures with each a slightly different focus: Box and Block Test (BBT; timed unilateral gross motor dexterity), Chedoke Arm Hand Activity Inventory (CAHAI; focusing on bilateral task execution), Wolf Motor Function Test (WMFT; uni- and bilateral timed performance and ability scoring), Nine Hole Peg Test (NHPT, timed unilateral fine motor dexterity); and the ABILHAND
Summary
Technology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabili‐ tation of neurological conditions, but use in clinical practice remains limited. Agreement on a core set of reliable, valid and accessible outcome measures to assess rehabilitation outcomes is needed to generate strong evidence about effectiveness of rehabilitation approaches, including technologies. The result is increasing pressure on the healthcare system globally and frames the need for effective and efficient approaches to enable and maintain access to care. Recent advances in neurorehabilitation research have resulted in a better understanding of recovery, giving rise to new promising approaches such as increased intensity of practice, early intervention and use of technology. The use of technology in rehabilitation may help alleviate the pressure on the healthcare system. Technologies could enable access to rehabilitation throughout the lifespan and has been advocated by the World Health Organisation (WHO) as an investment in human capital that contributes to health, economic and social development [2]
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