Development of European evidence-based recommendations for evaluation of the upper limb neurorehabilitation

Background Although use of standardized and scientifically sound outcome measures is highly encouraged in clinical practice and research, there is still no clear recommendation on which tools should be preferred for upper limb assessment. Agreement on measures in neurorehabilitation is also required to facilitate multi-center research and meta-analysis. The European Network on Robotics for Neurorehabilitation, funded by the European Co-operation in science and technology (COST) action is developing evidence-based recommendations for evaluation of the upper limb in neurorehabilitation. The primary aim of the recommendations is to improve the quality of upper limb neurorehabilitation through the adoption of standardized, agreed protocols for assessment and choice of measurement tools in research and clinical practice. The secondary aim is to inform and influence the development of new upper limb neurorehabilitation technologies both as therapies and assessment tools and to translate useful technologies into clinical practice. Methods The Recommendations will incorporate 3 sources of evidence: systematic reviews of upper limb outcome measures, current clinical guidelines and Delphi consensus methodology in stroke and neurorehabilitation. Results Systematic reviews: From 13 systematic reviews, 53 measures were identified of which 13 met the standardized criteria for the psychometric properties. The strongest level of measurement quality and clinical utility was demonstrated for Fugl-Meyer Assessment, Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Wolf Motor Function Test and ABILHAND. Clinical guidelines: Both National and published guidelines recommend assessment within the ICF framework. The National Guidelines provide little guidance on assessment beyond that valid, reliable and responsive measurement tools should be used by trained personnel. Delphi consensus: Consensus recommends a framework for assessment including categories and, where possible, specific measures (clinical and technology-based), definition of a minimum set of measures, duration and frequency for assessments. Conclusions The final recommendations will include the purpose of assessment, recommendations on when and by whom assessments should be conducted, how long an assessment should take and what measures and tools should be used. Recommendations are made for clinical practice and research separately. A minimum set of measures will be recommended f