You do realize how fucking useless 'measurements' are to getting survivors recovered? Or do you not understand what survivors want?
I consider this Roundtable worthless until they listen to survivors!
Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable
Abstract
Background:
Mobility
is a key priority for stroke survivors. Worldwide consensus of
standardized outcome instruments for measuring mobility recovery after
stroke is an essential milestone to optimize the quality of stroke
rehabilitation and recovery studies and to enable data synthesis across
trials.
Methods:
Using
a standardized methodology, which involved convening of 13 worldwide
experts in the field of mobility rehabilitation, consensus was
established through an a priori defined survey-based approach
followed by group discussions. The group agreed on balance- and
mobility-related definitions and recommended a core set of outcome
measure instruments for lower extremity motor function, balance and
mobility, biomechanical metrics, and technologies for measuring quality
of movement.
Results:
Selected
measures included the Fugl-Meyer Motor Assessment lower extremity
subscale for motor function, the Trunk Impairment Scale for sitting
balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and
Berg Balance Scale (BBS) for standing balance. The group recommended the
Functional Ambulation Category (FAC, 0–5) for walking independence, the
10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test
(6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for
complex walking. An FAC score of less than three should be used to
determine the need for an additional standing test (FAC < 3, add BBS
to Mini-BESTest) or the feasibility to assess walking (FAC < 3,
10 mWT, 6 MWT, and DGI are “not testable”). In addition, recommendations
are given for prioritized kinetic and kinematic metrics to be
investigated that measure recovery of movement quality of standing
balance and walking, as well as for assessment protocols and preferred
equipment to be used.
Conclusions:
The
present recommendations of measures, metrics, technology, and protocols
build on previous consensus meetings of the International Stroke
Recovery and Rehabilitation Alliance to guide the research community to
improve the validity and comparability between stroke recovery and
rehabilitation studies as a prerequisite for building high-quality,
standardized “big data” sets. Ultimately, these recommendations could
lead to high-quality, participant-specific data sets to aid the progress
toward precision medicine in stroke rehabilitation.
Introduction
Stroke
is a major disabling condition in the adult population worldwide, and
recovery of post-stroke mobility is largely dependent on the ability to
regain lower extremity function, sitting, and standing balance.1 The International Classification of Functioning, Disability and Health (ICF) framework2 defines “mobility” as: (1) changing and maintaining body position (d410-d429), (2) carrying, moving, and handling objects (d430-d449), (3) walking and moving (d450-d469), and (4) moving around using transportation (d470-d489).2 These functions determine independence in mobility and are often chosen as a rehabilitation priority by stroke survivors.3 Consequently, improving mobility is selected as a primary objective in stroke recovery and rehabilitation trials.4,5 Although epidemiological studies remain scarce,6 prospective cohort studies suggest that 807–95%8
of people with stroke regain walking independence, with or without the
use of walking aids, within the first 3–6 months post-stroke.6 This rate drops to 60% in individuals unable to walk in the first week post-stroke.9 Besides the strong time-dependency of using outcome measurement instruments (OMIs) in the first 3 months,10 recovery of walking has been significantly associated with factors, such as an intact corticospinal tract,11 muscle strength of the most affected lower extremity,11 continence,11 sitting,12 standing balance,13 and cognition.11
Currently,
the comparison or pooling of existing prognostic stroke studies and
trials applying similar interventions is hindered by the heterogeneity
of mobility-related OMI.11,14
For example, many different distances are used in the literature to
measure walking speed, such as the 3, 5, 7, 8, 10, or 12 meters.15 Each walking speed test is based on different testing protocols resulting into different psychometric properties.15
Standardization of OMI allows for meta-synthesis of data from different
studies needed for adequate power exploration of the many complex body
functions that underpin independent mobility. Thus, there is an urgent
need for a recommended core set of OMI allowing synthesis and comparison
of participant data. Ultimately, these recommendations could lead to
high-quality, participant-specific data sets to aid the progress toward
precision medicine in stroke rehabilitation.
So
far, no overarching recommendations for using the same OMI and
biomechanical metrics for balance and mobility exists in the stroke
research community. Existing recommendations15,16,17 that guide clinical practice are too elaborate, as they recommend without substantiating multiple OMI for the same construct16
whereas recommendations on biomechanical metrics are lacking for
measuring balance and mobility. Consensus on measuring the fine-grained
movement quality measures that are sensitive and specific, able to
capture small behavioral changes, is imperative, not only for
distinguishing behavioral restitution from compensation in stroke
recovery and rehabilitation trials, but also to make proper
interpretation of longitudinal neuroimaging studies (e.g. functional
magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), and
electroencephalography (EEG)) that may underly functional recovery
post-stroke.18
The
International Stroke Recovery and Rehabilitation Alliance aims to
facilitate breakthroughs for stroke survivors through global
collaborations on specific themes.19
Through this initiative, we invited international experts in the field
of stroke mobility to take part in the third Stroke Recovery and
Rehabilitation Roundtable (SRRR3). The SRRR3 builds on achieved
consensus on defining different time points post-stroke,20 recommended core set of OMI (SRRR1)21 and biomechanical metrics to measure quality of upper extremity movement (SRRR2).18 These metrics allow us to differentiate between recovery achieved from behavioral restitution or compensation.22
Furthermore, the achieved consensus is based on different ICF
constructs and includes recommendations on standardized assessment
protocols, and equipment for quantitative assessment of mobility.
Therefore, the work in this SRRR3 addressed the following questions to
aid future stroke rehabilitation and recovery studies:
1.
Which
baseline characteristics for participants should be added to the SRRR1
recommendations in the field of lower extremity motor function, balance,
and mobility?
2.
At
what time points within the first 6 months post-stroke should lower
extremity motor function, balance, and mobility outcomes be measured?
3.
How should constructs of lower extremity motor function, balance, and mobility be defined?
4.
Which
core set of OMI and accompanying assessment protocols should be
recommended for investigating lower extremity motor function, balance
and mobility post-stroke?
5.
Which biomechanical metrics should be recommended for quantifying quality of balance and mobility recovery post-stroke?
6.
Which types of technological equipment should be recommended for measuring quality of balance and mobility recovery post-stroke?
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