Consensus on key evaluation tools for stroke: a Delphi study protocol for the assessment of balance and gait

Stroke is a leading cause of long-term disability, and gait and balance impairments significantly affect post-stroke independence and quality of life. Following rehabilitation, patients can regain walking and balance abilities. These gains may occur through true recovery, characterized by the restoration of pre-stroke motor patterns and underlying neural functions and structures, or through compensation, characterized by the use of alternative movement strategies and neural reorganization. Identifying outcome measures that describe gait and balance recovery and distinguish true recovery from compensation could greatly improve the accuracy of functional diagnosis and help tailor rehabilitation by guiding strategy selection. This protocol outlines a Delphi study to establish expert consensus on the most appropriate assessment tools for gait and balance in people with stroke and on their ability to differentiate between recovery and compensation across the International Classification of Functioning, Disability and Health (ICF) domains. The resulting tool set will support individualized, evidence-based rehabilitation strategies.

The Delphi study employs a two-phase design comprising an initial expert focus group followed by a multi-round electronic Delphi process. The focus group will identify key constructs and candidate tools to assess either recovery or compensation. In the Delphi rounds, a panel of 30 to 50 international experts in stroke rehabilitation will rate the relevance of tools, including clinical scales, instrumented assessments of motor performance, and neural information, across the ICF domains. Consensus will be defined as ≥75% agreement, and iterative rounds will refine item selection based on panel feedback.

The study will produce a consensus-based core set of assessment tools for evaluating post-rehabilitation gait and balance recovery after stroke, capable of distinguishing true recovery from compensation. These tools will facilitate more precise diagnosis, patient stratification, and targeted interventions. Additionally, the study will support the design of future research protocols, including cross-sectional and longitudinal studies of stroke rehabilitation outcomes.

This study aims to advance precision rehabilitation after stroke by identifying outcome measures that distinguish true recovery from compensatory strategies. A Delphi methodology will provide a rigorous, consensus-driven basis for selecting clinically meaningful tools, thereby enhancing assessment accuracy and potentially improving rehabilitation outcomes.