Evaluation of upper extremity neurorehabilitation using technology: a European Delphi consensus study within the EU COST Action Network on Robotics for Neurorehabilitation.
BACKGROUND
The need for cost-effective neurorehabilitation is driving investment into technologies for patient assessment and treatment. Translation of these technologies into clinical practice is limited by a paucity of evidence for cost-effectiveness. Methodological issues, including lack of agreement on assessment methods, limit the value of meta-analyses of trials. In this paper we report the consensus reached on assessment protocols and outcome measures for evaluation of the upper extremity in neurorehabilitation using technology. The outcomes of this research will be part of the development of European guidelines.


METHODS
A rigorous, systematic and comprehensive modified Delphi study incorporated questions and statements generation, design and piloting of consensus questionnaire and five consensus experts groups consisting of clinicians, clinical researchers, non-clinical researchers, and engineers, all with working experience of neurological assessments or technologies. For data analysis, two major groups were created: i) clinicians (e.g., practicing therapists and medical doctors) and ii) researchers (clinical and non-clinical researchers (e.g. movement scientists, technology developers and engineers).


RESULTS
Fifteen questions or statements were identified during an initial ideas generation round, following which the questionnaire was designed and piloted. Subsequently, questions and statements went through five consensus rounds over 20 months in four European countries. Two hundred eight participants: 60 clinicians (29 %), 35 clinical researchers (17 %), 77 non-clinical researchers (37 %) and 35 engineers (17 %) contributed. At each round questions and statements were added and others removed. Consensus (≥69 %) was obtained for 22 statements on i) the perceived importance of recommendations; ii) the purpose of measurement; iii) use of a minimum set of measures; iv) minimum number, timing and duration of assessments; v) use of technology-generated assessments and the restriction of clinical assessments to validated outcome measures except in certain circumstances for research.


CONCLUSIONS
Consensus was reached by a large international multidisciplinary expert panel on measures and protocols for assessment of the upper limb in research and clinical practice. Our results will inform the development of best practice for upper extremity assessment using technologies, and the formulation of evidence-based guidelines for the evaluation of upper extremity neurorehabilitation.
Faculty of Health Sciences, University of Southampton, Southampton, UK. A.Hughes@soton.ac.uk.
Ann-Marie
http://orcid.org/0000-0002-3958-8206
AM
Hughes
Department of Psychology, School of Health & Social Sciences, Buckinghamshire New University, High Wycombe, UK.
Sofia Barbosa
SB
Bouças
Faculty of Health Sciences, University of Southampton, Southampton, UK.
Jane H
JH
Burridge
Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Margit
M
Alt Murphy
Roessingh Research and Development, Enschede, The Netherlands.|Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.
Jaap
J
Buurke
REVAL- Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
Peter
P
Feys
Sensory Motor Systems Lab, Department of Health Science and Technologies, Swiss Federal Institute of Technology, Zurich, Switzerland.
Verena
V
Klamroth-Marganska
REVAL- Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
Ilse
I
Lamers
Roessingh Research and Development, Enschede, The Netherlands.|Department of Mechanical Engineering, University of Twente, Enschede, The Netherlands.
Gerdienke
G
Prange-Lasonder
REVAL- Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
Annick
A
Timmermans
Neurorehabilitation Department, Health Division, TECNALIA Research & Innovation, Donostia-San Sebastián, Spain.
Thierry
T
Keller
Assessment; Evaluation; Neurology; Outcome measures; Rehabilitation technology; Robotics; Upper extremity
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