International consensus recommendations for outcome measurement in post-stroke arm rehabilitation trials

Julie Duncan Millar*, Frederike van Wijck, Alex Pollock, Myzoon Ali

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Existing randomised controlled trials (RCTs) of arm rehabilitation interventions after stroke use a wide range of outcome measures, limiting ability to pool data to determine efficacy. Published recommendations also lack stroke survivor, carer and clinician involvement specifically about perceived relevance and importance of outcomes and measures.

AIM: To generate international consensus recommendations for selection of outcome measures for use in future stroke RCTs in arm rehabilitation considering outcomes important to stroke survivors, carers and clinicians. The recommendations are the Standardising Measurement in Arm Rehabilitation Trials [SMART] toolbox.

DESIGN: Two-round international e-Delphi survey and consensus meeting.

SETTING: Online and University.

POPULATION: Fifty-five researchers and clinicians with expertise in stroke upper limb rehabilitation from 18 countries (e-Delphi); n=13 researchers and clinicians, n=2 stroke survivors, n=1 carer (consensus meeting).

METHODS: Using systematically identified outcome measures from published RCTs, we conducted a two-round international e-Delphi survey with researchers and clinicians to identify the most important measures for inclusion in the toolbox. Measures that achieved ≥60% consensus were categorised using the International Classification of Functioning, Disability and Health framework (ICF); psychometric properties were ascertained from literature and research resources. At a final consensus meeting, expert stakeholders selected measures for inclusion in the toolbox.

RESULTS: E-Delphi participants recommended 28/170 measures for discussion at the final consensus meeting. Expert stakeholders (n=16) selected the Visual Analogue Scale for pain/ 0-10 Numeric Pain Rating Scale, Dynamometry, Action Research Arm Test, Wolf Motor Function Test, Barthel Index, Motricity Index and Fugl-Meyer Assessment (upper limb section of each), Box and Block Test, Motor Activity Log 14, Nine Hole Peg Test, Functional Independence Measure, EQ-5D, and Canadian Occupational Performance Measure for inclusion in the toolbox.

CONCLUSIONS: The SMART Toolbox provides a refined selection of measures that capture outcomes considered important by stakeholders for each ICF domain.

CLINICAL REHABILITATION IMPACT: The toolbox will facilitate data aggregation for efficacy analyses thereby strengthening evidence to inform clinical practice. Clinicians can also use the toolbox to guide selection of measures ensuring a patient-centred focus.
Original languageEnglish
Pages (from-to)61-68
Number of pages8
JournalEuropean Journal of Physical and Rehabilitation Medicine
Volume57
Issue number1
Early online date20 Nov 2020
DOIs
Publication statusPublished - Feb 2021

Keywords

  • stroke; outcome measure; upper limb; rehabilitation; outcome; consensus

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