A recent article, published by researchers from the Autonomous University of Madrid (UAM) in the British Journal of Occupational Therapy , recommends and classifies the assessment tools necessary for upper limb recovery in patients who have suffered a stroke.
A panel of 29 occupational therapists from 11 autonomous communities participated in the study. After 3 rounds, the dropout rate was 31%. Of the 129 evaluation tools proposed, 23 reached consensus. Of them, 7 were classified, according to the International Classification of Functioning, Disability and Health (ICF), in the body functions and structures component; 11 in activities; 3 in participation; and 2 as "others".
“The resulting recommendations aim to help occupational therapists in making decisions about which assessment tools to choose in MS recovery after a stroke, improving the quality of clinical practice,” the authors highlight.
“Also,” they add, “they have the potential to reduce the heterogeneity of the tools used in research, favoring the performance of meta-analyses, essential to advance the understanding of recovery from the after-effects of stroke. However, the tools will need to be reviewed and updated periodically to reflect advances in the diagnosis of MS dysfunction in stroke.”
The need for consensus
Cerebrovascular accident (CVA) is one of the main causes of disability in the world. Among the consequences it leaves, the involvement of the upper limb (MS) stands out, associated with limitations in activities and restrictions in participation. Therefore, improving the functionality of the MS is a priority objective.
The evaluation of MS after a stroke is important in both clinical practice and research. To measure the multidimensional deficits of SM and understand their impact on life, the International Classification of Functioning, Disability and Health (ICF) can be used.
However, in clinical practice guidelines there is a lack of consensus on the tools that should be used for the evaluation of SM after a stroke, and there is great heterogeneity between countries, which makes it necessary to explore geographical preferences.
The current lack of explicit recommendations may hinder the understanding of recovery mechanisms and the design of more effective treatments. Furthermore, in recent Delphi studies on assessment tools in stroke, occupational therapists were underrepresented.
Consensus rounds
The researchers conducted a nationwide, longitudinal, quantitative electronic Delphi study. To constitute the panel of experts, occupational therapists working in Spain in clinical, teaching or research, with postgraduate studies in neurological pathology and at least 10 years of experience in acquired brain damage were recruited through non-probabilistic sampling.
Regarding the instruments, they used an ad hoc questionnaire to collect demographic, academic and work data from the experts, and another ad hoc questionnaire on evaluation tools for MS in stroke.
Each tool was accompanied by a 9-point Likert scale to rate its importance in MS recovery. Scores of 1 to 3 indicated “low importance,” 4 to 6 “uncertain importance,” and 7 to 9 “high importance.”
Thus, 3 consecutive rounds of consensus were carried out between February and July 2022. The experts had one month to respond to the questionnaire for each round. When at least 75% of the experts rated a tool with a score of 7 to 9 on the Likert scale, consensus was reached.
If a tool did not reach consensus, two situations could arise: if the median of the scores was ≥ 7, the tool moved on to the next round of consensus; and if the median was ≤ 6, the tool was eliminated.
In this way, the authors were able to carry out a descriptive analysis of the results, using percentages and measures of central tendency. In rounds 2 and 3, they offered individualized feedback on the scores from the previous round and sheets on the characteristics of the tools, so that the experts could reflect on their scores.
Image: Stroke is one of the leading causes of disability in the world /National Cancer Institute on Unsplash
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Bibliographic reference: Madroñero-Miguel, B.; Cuesta-García, C. (2023). Spanish consensus of occupational therapists on upper limb assessment tools in stroke . British Journal of Occupational Therapy , 0(0). doi.org/10.1177/03080226231175574
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