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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.00567

A review of international clinical guidelines for rehabilitation of people with neurological conditions: what recommendations are made for upper limb assessment?

  • 1Faculty of Health Sciences, University of Southampton, United Kingdom
  • 2Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
  • 3Roessingh Research and Development, Netherlands
  • 4Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Netherlands
  • 5REVAL Rehabilitation Research Center, Belgium
  • 6Tecnalia Research & Innovation, Spain
  • 7Zurich University of Applied Sciences, Switzerland
  • 8Faculty of Engineering Technology, University of Twente, Netherlands
  • 9Faculty of Sport and Health Sciences, University of Jyvaskyla, Finland

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 be 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 assessing 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 standardised 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.

Keywords: Practice guidelines, Neurological conditions, Upper limb, outcome and process assessment, Systematic review, guidelines, impairment

Received: 08 Jan 2019; Accepted: 13 May 2019.

Edited by:

Mariano Serrao, Sapienza University of Rome, Italy

Reviewed by:

Giovanni Morone, Fondazione Santa Lucia (IRCCS), Italy
Marianna Capecci, Marche Polytechnic University, Italy  

Copyright: © 2019 Burridge, Hughes, Alt Murphy, Buurke, Feys, Keller, Klamroth-Marganska, Lamers, McNicholas, Prange-Lasonder, Tarkka and Timmermans. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Jane H. Burridge, Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, Hampshire, United Kingdom,