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International Journal of Stroke 19(2)
Figure 1. Stages of consensus building.
4. Which core set of OMI and accompanying assessment
protocols should be recommended for investigating
lower extremity motor function, balance and
mobility post-stroke?
5. Which biomechanical metrics should be recommended
for quantifying quality of balance and
mobility recovery post-stroke?
6. Which types of technological equipment should be
recommended for measuring quality of balance and
mobility recovery post-stroke?
Methods
Consensus building
from compensation in stroke recovery and rehabilitation
trials, but also to make proper interpretation of longitudinal
neuroimaging studies (e.g. functional magnetic resonance
imaging (fMRI), diffusion tensor imaging (DTI), and electroencephalography
(EEG)) that may underly functional
recovery post-stroke.18
The International Stroke Recovery and Rehabilitation
Alliance aims to facilitate breakthroughs for stroke survivors
through global collaborations on specific themes.19
Through this initiative, we invited international experts in
the field of stroke mobility to take part in the third Stroke
Recovery and Rehabilitation Roundtable (SRRR3). The
SRRR3 builds on achieved consensus on defining different
time points post-stroke,20 recommended core set of OMI
(SRRR1)21 and biomechanical metrics to measure quality
of upper extremity movement (SRRR2).18 These metrics
allow us to differentiate between recovery achieved from
behavioral restitution or compensation.22 Furthermore, the
achieved consensus is based on different ICF constructs
and includes recommendations on standardized assessment
protocols, and equipment for quantitative assessment of
mobility. Therefore, the work in this SRRR3 addressed the
following questions to aid future stroke rehabilitation and
recovery studies:
1. Which baseline characteristics for participants
should be added to the SRRR1 recommendations in
the field of lower extremity motor function, balance,
and mobility?
2. At what time points within the first 6 months poststroke
should lower extremity motor function, balance,
and mobility outcomes be measured?
3. How should constructs of lower extremity motor
function, balance, and mobility be defined?
International Journal of Stroke, 19(2)
The SRRR3 started with a " preparatory group " of four
members (GK, GV, TVC, CH) who formulated the research
questions (GK and GV), prepared evidence tables, and
designed questionnaires (TVC and CH). Two methodological
experts (KB and LC) were consulted, and all 11 stroke
research experts from North America (3), Europe (7), and
Asia (1) accepted the invitation to join the " core group. "
Established experts as well as emerging leaders were
selected based on their professional background (physiotherapy
and movement sciences) and impact of their scientific
publications in the fields of balance and/or mobility
post-stroke. None of the invited experts of the core group
had a conflict of interest. A five-stage process following a
voting-based graph theory was undertaken to form consensus
(Figure 1),23 consisting of three online questionnaires
followed by three online meetings and one hybrid meeting
to discuss the six research questions. The methods employed
were the same as in previous SRRR.18,21
Stage 1
Prior to administering the online questionnaires, the preparatory
group performed a scoping review to identify current
OMI being used in stroke research, by compiling the
evidence of 60 reviews on mobility interventions and on
measurement properties. Subsequently, a summary of balance
and mobility-related definitions, measurement properties
of OMI, and biomechanical metrics in stroke
rehabilitation was extracted from 220 studies (167 clinical
and 53 biomechanical studies) and presented in a tabular
overview (see Supplemental Appendix 1). Relevant studies
were only included when OMI and assessment protocols
were published in a peer-reviewed journal and at least
one of the following measurement properties was reported:
reliability, validity, internal consistency, ceiling/floor
effects, responsiveness, minimal detectable change, minimal
important clinical difference, and measurement error.
Tables were structured in agreement with the international
consensus guidelines of COSMIN24and COMET.25
The tables in Supplemental Appendix 1 representing the
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