From Metrics to Meaning in Neurological Rehabilitation: Clinicians' Perspectives on Digital Metrics of Upper Limb Functioning-A Focus Group Study.
Johannes Pohl, Laura Mayrhuber, Olivier Lambercy and 1 others
Clinicians said digital upper limb metrics are only interpretable alongside basic ROM, strength, and grasp checks, and that the right metrics depend on the diagnosis.
They preferred simple measures like task duration over complex kinematic values, and valued real-world arm use patterns over lab-based capacity scores.
Key findings
1Clinicians identified four functional prerequisites (ROM, strength, selective muscle control, grasping) as the foundation needed before any digital movement metric can be interpreted. Without these, technology-driven assessments risk misrepresenting a patient's true abilities.
2Task duration was the most consistently valued kinematic metric across all professions. Clinicians also prioritized compensatory movement patterns (excessive trunk flexion, shoulder elevation) as markers of motor impairment, and valued continuous real-world arm use profiles (timing, symmetry, endurance) over isolated lab-based capacity scores.
3Metric relevance is diagnosis-specific: between-limb symmetry is meaningful for unilateral conditions like stroke but loses interpretive value in bilateral conditions like SCI. Clinicians stressed that standardized protocols often fail to capture patient-specific differences, particularly in severe impairment.
Still to come
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What it does not show
Only 3 of 8 invited clinics participated (38%), primarily due to organizational constraints in releasing staff for a 90-minute session. Eleven participants across three small groups; the authors state thematic saturation cannot be assumed and findings are exploratory and context-dependent. Recruitment through clinic nomination may have favored clinicians already open to digital assessment, although skeptical views also emerged. The concept of 'relevance' was not operationalized with predefined criteria, so participants may have interpreted it differently (usefulness, familiarity, feasibility, patient-centeredness). All discussions were anchored to a single drinking task video, which may have introduced contextual bias and limited generalizability to other upper limb activities. Both moderators were clinician-researchers, introducing potential social desirability bias. Feasibility, usability, and data-quality requirements of the measurement technologies were intentionally set aside and not evaluated. Findings are from Swiss inpatient neurorehabilitation and may not transfer to outpatient settings, other health systems, or other languages and cultures.
Declared interests
Funded by the P&K Puhringer Foundation. Two authors (JP, CA) were involved in early pilot work related to the learning health system discussed in the paper, but state this was in a noncommercial research context and does not constitute a conflict of interest.
The easy way to misread this
Do not read these themes as a validated set of metrics to adopt in your clinic. Eleven clinicians in three Swiss clinics described what they would find useful; no metric was tested for clinical utility, and the recruitment method (clinic nomination) may have favored those already open to digital assessment.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →