[ARTICLE] A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions: What Recommendations Are Made for Upper Limb Assessment? – Full Text

Background: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life, and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation.

Aim: To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment.

Methods: We systematically reviewed published guidance on measures and protocols for assessment of upper limb function in neurological rehabilitation via electronic databases from January 2007–December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to “rehabilitation” and “assessment” or “measurement”. Reasons for exclusion were documented.

Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion, and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardized measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation.

Conclusions: We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.


Worldwide prevalence of stroke in 2010 was 33 million, with 16.9 million people having a first stroke, of which 795,000 were American and 1.1 million European (1). It has been estimated that approximately one third of people fail to regain upper limb capacity, despite receiving therapy (2). This has important implications for both individuals and the wider society as reduced upper limb function is associated with dependence and poor quality of life for both patients and carers (35) and impacts on national economies (6).

While stroke has the highest prevalence, other neurological conditions such as Multiple Sclerosis (MS), Spinal Cord Injury (SCI), and Traumatic Brian Injury, have a significant incidence and there are often similarities in presentation, and treatment and therefore assessment. The worldwide incidence of SCI is 40–80 cases per million population and the estimated European mean annual rate of MS incidence is 4.3 cases per 100,000 (7). Recently, Kister et al. (8) reported that 60% of people with MS have impaired hand function. The impact of upper limb dysfunction on ADL is higher than in stroke, as both sides are often affected (9). Although dysfunction after SCI depends on level of injury, upper limb function is consistently cited as a health priority. The incidence rate of TBI in Europe is about 235 per 100,000 population (10). Outcome data among European countries are very heterogeneous. From the US however, it is known that about 1.1% of the population suffer a TBI resulting in long term disability (11).


Continue —>  Frontiers | A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions: What Recommendations Are Made for Upper Limb Assessment? | Neurology

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