Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel.
Jessica Nolan, Angela Jacques, Erin Godecke and 22 others
PMID 37122265WHAT IT FOUND
Experts agreed on 119 recommendations for lateropulsion care, prioritising tactile cues and active self-correction over passive correction.
They rejected routine use of novel tech like VR. No consensus was reached on optimal therapy dose, leaving that to clinical judgement.
Key findings
01Consensus was reached on 119 recommendations covering education, rehabilitation strategies, positioning, fear of falling, and discharge planning.
02The panel recommended against routine use of interventions such as virtual reality, video games, and brain stimulation due to insufficient evidence.
03Experts failed to reach consensus on specific therapy dose recommendations, showing wide variation in opinion.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The recommendations are based on expert opinion, not tested interventions, as no critical literature review was conducted. The panel was limited to English-speaking experts, and 95% were from high-income countries, which may limit global applicability. No consensus was reached on optimal therapy dose, leaving this aspect of management to individual clinical judgement. The study did not address underlying mechanisms of lateropulsion or specific stroke types/locations.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not treat these recommendations as evidence-based guidelines for efficacy. They represent expert consensus on 'usual care' where high-quality evidence is lacking. Specifically, do not assume the recommended strategies have been proven to improve outcomes more than other approaches, and note that the panel explicitly rejected routine use of several popular novel interventions due to insufficient evidence.