From the Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (A.S., A.R.L., J.M.V.).
cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.S., A.R.L., J.M.V.).
Stroke. 2019 Mar;50(3):718-727. doi: 10.1161/STROKEAHA.118.023531.
Background and Purpose- Assessing upper limb movements poststroke is crucial to monitor and understand sensorimotor recovery. Kinematic assessments are expected to enable a sensitive quantification of movement quality and distinguish between restitution and compensation. The nature and practice of these assessments are highly variable and used without knowledge of their clinimetric properties. This presents a challenge when interpreting and comparing results. The purpose of this review was to summarize the state of the art regarding kinematic upper limb assessments poststroke with respect to the assessment task, measurement system, and performance metrics with their clinimetric properties. Subsequently, we aimed to provide evidence-based recommendations for future applications of upper limb kinematics in stroke recovery research. Methods- A systematic search was conducted in PubMed, Embase, CINAHL, and IEEE Xplore. Studies investigating clinimetric properties of applied metrics were assessed for risk of bias using the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. The quality of evidence for metrics was determined according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Results- A total of 225 studies (N=6197) using 151 different kinematic metrics were identified and allocated to 5 task and 3 measurement system groups. Thirty studies investigated clinimetrics of 62 metrics: reliability (n=8), measurement error (n=5), convergent validity (n=22), and responsiveness (n=2). The metrics task/movement time, number of movement onsets, number of movement ends, path length ratio, peak velocity, number of velocity peaks, trunk displacement, and shoulder flexion/extension received a sufficient evaluation for one clinimetric property. Conclusions- Studies on kinematic assessments of upper limb sensorimotor function are poorly standardized and rarely investigate clinimetrics in an unbiased manner. Based on the available evidence, recommendations on the assessment task, measurement system, and performance metrics were made with the goal to increase standardization. Further high-quality studies evaluating clinimetric properties are needed to validate kinematic assessments, with the long-term goal to elucidate upper limb sensorimotor recovery poststroke. Clinical Trial Registration- URL: https://www.crd.york.ac.uk/prospero/ . Unique identifier: CRD42017064279.
背景与目的-评估脑卒中后上肢运动对于监测和理解感觉运动恢复至关重要。运动学评估有望实现对运动质量的敏感量化，并区分恢复和代偿。这些评估的性质和实践差异很大，而且在不知道其临床计量学特性的情况下使用。这在解释和比较结果时带来了挑战。本综述的目的是总结脑卒中后上肢运动学评估的最新技术，包括评估任务、测量系统以及性能指标及其临床计量学特性。随后，我们旨在为未来在脑卒中恢复研究中应用上肢运动学提供循证建议。
方法-在 PubMed、Embase、CINAHL 和 IEEE Xplore 中进行了系统检索。使用 151 种不同运动学指标对进行了临床计量学特性评估的研究，使用共识基础的健康测量仪器选择标准检查表评估偏倚风险。根据推荐评估、制定和评估方法，确定了指标的证据质量。
结果-共确定了 225 项研究（N=6197），使用了 151 种不同的运动学指标，并分为 5 个任务和 3 个测量系统组。有 30 项研究评估了 62 种指标的临床计量学特性：可靠性（n=8）、测量误差（n=5）、收敛有效性（n=22）和反应性（n=2）。运动/时间任务、运动起始次数、运动结束次数、路径长度比、峰值速度、速度峰值数、躯干位移和肩部屈伸的指标获得了一项临床计量学特性的充分评估。
结论-上肢感觉运动功能运动学评估的研究标准化程度较差，并且很少以无偏倚的方式研究临床计量学。基于现有证据，对评估任务、测量系统和性能指标提出了建议，旨在提高标准化程度。进一步需要高质量的研究来评估临床计量学特性，以验证运动学评估，最终目标是阐明脑卒中后上肢感觉运动的恢复情况。
临床试验注册- URL：https://www.crd.york.ac.uk/prospero/ 。唯一标识符：CRD42017064279。
