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Van Criekinge T, Heremans C, Burridge J, Deutsch JE, Hammerbeck U, Hollands K, Karthikbabu S, Mehrholz J, Moore JL, Salbach NM, Schröder J, Veerbeek JM, Weerdesteyn V, Borschmann K, Churilov L, Verheyden G, Kwakkel G. Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2024; 19:158-168. [PMID: 37824730 DOI: 10.1177/17474930231205207] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
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.
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Affiliation(s)
| | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Judith E Deutsch
- RiVERS Lab, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - Ulrike Hammerbeck
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust and The Tamil Nadu Dr. M.G.R. Medical University, Coimbatore, India
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Nancy M Salbach
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | | | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - Karen Borschmann
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
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Van Criekinge T, Heremans C, Burridge J, Deutsch JE, Hammerbeck U, Hollands K, Karthikbabu S, Mehrholz J, Moore JL, Salbach NM, Schröder J, Veerbeek JM, Weerdesteyn V, Borschmann K, Churilov L, Verheyden G, Kwakkel G. Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:41-51. [PMID: 37837351 DOI: 10.1177/15459683231209154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
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.
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Affiliation(s)
| | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Judith E Deutsch
- RiVERS Lab, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - Ulrike Hammerbeck
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust and The Tamil Nadu Dr. M.G.R. Medical University, Coimbatore, India
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Nancy M Salbach
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | | | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - Karen Borschmann
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
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