European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus.

The recommendations are for assessment, not a test of whether therapy changes patient outcomes. Most evidence is from stroke, so they are less certain for spinal cord injury, multiple sclerosis, or traumatic brain injury. Kinematic and sensor-based measures are included, but standard ways to use and analyse them, and their psychometric properties, are not well established for routine clinical practice. No specific patient-reported outcome measure other than ABILHAND, and no specific goal attainment measure, could be recommended. Cultural differences in task-based assessment were not directly addressed, and shortened or revised versions of some measures were not considered. Assessment procedure recommendations came mainly from guidelines and consensus, with limited data, so they were not rated like the outcome measures. The Delphi consensus required at least 69% agreement, so some recommendations reflect expert agreement as well as systematic evidence.

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Do not read CAULIN as proof that these assessments improve patient recovery. It synthesises evidence and expert agreement on what to measure, not a trial testing whether the measures or therapies change outcomes.