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Published on: June 12, 2019
Post-stroke flexed elbow deformity management: consensus opinion from an international Delphi expert panel
Marjorie Salga1, Vincent T Carpentier1, Laure Gatin2
1Department of Physical Medicine and Rehabilitation, Perioperative Disability Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, Boulevard Raymond-Poincaré 104, 92380 Garches, France; UR 20262 Handistart, UFR Simone Veil Santé, Versailles Saint-Quentin-en-Yvelines University (UVSQ), Paris Saclay University, Ave de la Source de la Bièvre 4, 78180 Montigny le Bretonneux, France.
This study established international expert consensus on managing poststroke flexed elbow deformity. Key recommendations include functional assessment before treatment and combining botulinum toxin with rehabilitation for correctable cases.
Area of Science:
- Rehabilitation Medicine
- Orthopedic Surgery
- Neurosurgery
Background:
- Poststroke flexed elbow deformity is a common, disabling condition impacting daily function.
- Current assessment and treatment strategies are inconsistent and lack standardization across disciplines.
Purpose of the Study:
- To develop an international, interdisciplinary expert consensus on assessing and managing poststroke flexed elbow deformity.
- Utilize a hypothesis-driven Delphi methodology to achieve consensus.
Main Methods:
- An international Delphi process involving 28 experts from 12 countries across relevant specialties.
- Three rounds of anonymous online questionnaires to evaluate statements on diagnosis, assessment, and treatment.
- Consensus defined as ≥80% agreement among experts.
Main Results:
- 61 out of 164 statements (38%) reached consensus.
- Experts agreed functional assessment must precede treatment decisions.
- Botulinum toxin with rehabilitation is recommended for correctable deformities; surgery for non-correctable cases.
- Interdisciplinary consultation and goal setting are mandatory pre-intervention.
Conclusions:
- This consensus provides structured, interdisciplinary guidance for evaluating and managing poststroke flexed elbow deformity.
- Aims to standardize care pathways and improve patient outcomes.
- Clarifies assessment principles, treatment sequencing, and surgical indications.
