Clinical Outcome Assessments for Functional Performance in Spastic Paresis: Systematic Review, Critique, and...

Area of Science:

• Neurology
• Rehabilitation Medicine
• Clinical Outcome Assessment

Background:

• Spastic paresis, stemming from central nervous system lesions, severely impacts functional performance.
• Functional performance is defined within the International Classification of Functioning, Disability, and Health framework as activity-level functioning.
• There is a critical need for reliable clinical outcome assessments (COAs) to evaluate functional performance in spastic paresis.

Purpose of the Study:

• To systematically review and evaluate the clinimetric properties of functional performance COAs in spastic paresis.
• To provide evidence-based recommendations for the use of these COAs in clinical practice and research.

Main Methods:

• A comprehensive literature search identified relevant COAs for spastic paresis.
• An international expert panel systematically assessed the identified COAs.
• COAs were classified using the Movement Disorder Society-COA methodology into categories: 'recommended,' 'recommended with caveats,' 'suggested,' or 'listed.'

Main Results:

• Seventy-one COAs were initially identified; 14 were reviewed in detail based on usage frequency.
• Five COAs for lower limb functional performance met 'recommended' criteria.
• No upper limb COAs met 'recommended' criteria, but two were classified as 'recommended with caveats.'

Conclusions:

• The 10-Minute Walk Test variants, and the 2- or 6-Minute Walk Test, are recommended for lower limb functional performance assessment in spastic paresis.
• The Wisconsin Gait Scale is recommended for lower limb assessment, despite potential feasibility limitations.
• The 13-item Arm Motor Ability Test and Modified Frenchay Scale are 'recommended with caveats' for upper limb assessment due to identified limitations.