Implementation of evidence-based assessment of upper extremity in stroke rehabilitation: From evidence to clinical practice.
Margit Alt Murphy, Ann Björkdahl, Gunilla Forsberg-Wärleby and 1 others
PMID 33470413WHAT IT FOUND
Stroke therapists implemented a new upper extremity assessment guideline.
Short screening tests were adopted quickly, but the comprehensive Fugl-Meyer test required significant training time. Adherence to strict assessment timelines remained difficult due to workload and staff rotation.
Key findings
01The final guideline prioritized short screening tests (SAFE, ARAT-2) and established measures (BBT, 9HPT, grip strength) alongside the new FMA-UE, as performing both FMA-UE and ARAT was deemed unfeasible.
02While 91% of clinicians found the short SAFE test easy to integrate into routine, only 62% felt the same about ARAT-2, and 65% about the FMA-UE.
03Only 52% of respondents reported good adherence to the defined assessment time-points, with staff rotation and workload cited as primary barriers.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a single-site implementation study, so results may not generalize to other healthcare systems. Adherence data is self-reported via survey, not objectively verified from patient records. Patient perspectives were not included in the guideline development or evaluation. The study evaluates early implementation (one year post-release), so long-term sustainability and impact on patient outcomes are unknown. The guideline was developed by a small group of clinical researchers, which may bias the selection of measures towards those with strong psychometric properties rather than those with the highest clinical feasibility.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume this guideline improves patient outcomes. The study measures clinician adherence and perception, not functional recovery. Low adherence to time-points (52%) suggests the protocol is difficult to sustain in busy acute settings.