A systematic review of upper extremity outcome measures assessed in randomized controlled trials of post stroke upper extremity rehabilitation over time.

Abstract

BACKGROUND The heterogeneity in outcome measures of post stroke rehabilitation trials suggests the need for consensus approach in stroke recovery measurement. To reach this aim, it is important to understand the past and current use of outcome measures in randomized control trials (RCTs) of stroke rehabilitation. OBJECTIVE To systematically review RCTs of post stroke UE rehabilitation interventions to understand the use of UE outcome measures in research and their changes over time. METHODS CINAHL, Embase, PubMed, Scopus and Web of Science were searched from 1960 to 1 April 2021. Studies were eligible for inclusion if they (1) were RCTs or crossovers published in English (2) ≥50% of participants were affected by stroke, 3) included adults ≥ 18 years old, and (4) applied an intervention to the hemiparetic UE as the primary objective of the study. RESULTS 1,276 RCTs met inclusion criteria, and 112 different outcome measures were identified. Outcome measures were classified according to the International Classification of Functioning, Disability and Health (ICF) framework. Outcome measures most frequently assessed body function and structure (n = 1,692), followed by activities (n = 1,572) and participation (n = 162). The most used outcome measures were the Fugl-Meyer Assessment (n = 619), the modified Ashworth Scale (n = 255), Action Research Arm Test (n = 211), Wolf Motor Function Test (n = 184), and Box and Block Test (n = 178). CONCLUSIONS Understanding the breadth of outcome measures that have been used over time emphasizes the need for proposed standardization of outcome measures but also the need to adjust and expand consensus recommendations based on past and ongoing research trends.