Development of lower limb training interventions that promote an external focus of attention in people with stroke: a modified Delphi survey.
Louise Johnson, Jane Burridge, Sara Demain
PMID 34474651WHAT IT FOUND
Experts agreed on how to phrase stroke rehab instructions to keep attention on the goal, not the body movement.
They favored simple, positive cues like "touch the marker" over "don't touch" or naming body parts. This is guidance, not proof of improved walking.
Key findings
01Consensus was reached on 13 of 18 exercise examples, with one rejected for complexity despite meeting agreement thresholds.
02Panelists strongly agreed that instructions should be positive (e.g., "keep touching") rather than negative (e.g., "don't touch"), and that demonstrations should accompany verbal cues.
03There was no consensus on using mirrors for feedback, with half the panel believing a mirror's effect depends on other contextual factors.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The panel was small (13-14 respondents) and selected purposively, so it may not represent the views of all therapists. Anonymity requirements meant researchers could not track individual responses across rounds, so the exact same people did not necessarily complete all three rounds. The study defines how to create externally focused tasks but does not test whether these tasks actually improve motor recovery in patients. Consensus is not synonymous with best practice; it reflects agreement among a specific group of experts.
Declared interests
Funded by the National Institute for Health Research. No other conflicts of interest were declared.
The easy way to misread this
Do not interpret this as evidence that external focus instructions improve stroke recovery. This study only establishes that experts agree on how to phrase such instructions; the actual clinical benefit is being tested in a separate trial.