From Metrics to Meaning in Neurological Rehabilitation: Clinicians' Perspectives on Digital Metrics of Upper Limb...

Digital assessment technologies, such as optical motion capture and inertial measurement units, enable detailed kinematic analysis and continuous monitoring of upper limb activity in persons with neurological conditions. While such digital metrics of functioning are increasingly recognized in research, their uptake in clinical neurorehabilitation is limited. It remains unclear which digital metrics of functioning clinicians perceive as most meaningful and how these are integrated into patient-centered care. Understanding clinicians' information needs and reasoning processes is a prerequisite for implementing digital assessment technology.

This study aims to characterize how rehabilitation professionals perceive, prioritize, and integrate digital metrics of functioning into clinical reasoning and to identify features that would support their routine use.

Three 90-minute focus groups were conducted in 3 Swiss neurorehabilitation centers, involving 11 clinicians with diverse professional backgrounds (5 physiotherapists, 4 occupational therapists, 1 movement scientist, and 1 medical practitioner). Participants discussed essential parameter domains and individually rated the relevance and meaningfulness of 17 kinematic metrics for the well-studied drinking task and 10 established arm use performance metrics. Verbatim transcripts were analyzed using reflexive thematic analysis, and rating data were summarized descriptively.

Five main themes were identified. (1) Functional requirements to interpret movement quality and performance (active/passive range of motion, strength, selective muscle control, and grasp) form the basis for interpreting movement. (2) Essential aspects of movement quality (smoothness, efficiency, and compensatory movement) are valued when aligned with observable task execution. (3) Added value of real-world performance (hourly activity profiles, arm-use symmetry, and functional workspace) represents the reference for patient-centered reasoning. (4) Individualizing what matters, including diagnosis-specific preferences, shapes assessment selection. (5) Blending clinical eye and reference data reflects clinicians' reliance on visual judgment complemented by normative values. Intuitive metrics such as task duration, number of movement units, and range of motion were favored, whereas confidence was lower in more complex metrics (eg, jerk and interjoint coordination).

Clinicians value intuitive digital metrics of functioning when they are clearly linked to patient-centered outcomes and supported by normative references. The findings highlight the need for targeted educational strategies and digital competency training that help clinicians interpret digital metrics and integrate them with contextual information and clinical reasoning.