An essential step towards setting quality standards for clinical motor rehabilitation after stroke

Introduction of the ESO-core set for motor rehabilitation

The organisation of stroke services, evaluation of stroke outcomes, assessment of quality of care pathways and life after stroke are central domains targeted by the European Stroke Action Plan 2018-2030. Core sets of clinical outcome measures play an essential role for setting and evaluating quality standards of stroke care pathways.

For motor stroke rehabilitation, a large number of motor outcome measures exist and that leads to a large variability in clinical use. This and the lack of commonly agreed measurement time points are currently impeding comparability of stroke care pathways and quality control. Therefore, it was our goal to develop a consensus-based core set of outcome measures for the upper extremity, lower extremity, and ADL/ motor-related section for the International Classification of Functioning, Disability and Health (ICF) domains, including a framework of fixed measurement time points.

For this purpose, 34 experts in clinical stroke rehabilitation and research from 16 European countries participated in a 3-round Delphi study from November 2018 until March 2019. In this iterative process, a set of 119 outcome measures were reduced to a final core set of 9 outcome measures (see Table 1). The experts indicated that measurements should take place 6 times during the first 6 months after stroke and thereafter, should be repeated every 6th month (see Table 2). Herewith, the measurement scheme follows the non-linear pattern of recovery after stroke and also allows for monitoring in the chronic phase. The full details of this Delphi study will be published soon.

The strengths of the ESO-core set is that it is developed by experts of different backgrounds in stroke rehabilitation and that it provides a fixed measurement scheme. The multidisciplinary perspective of the set allows that various stroke team professionals can perform these measurements. This is helpful to reduce the burden for the individual health-care provider. As a next step, the ESO-core set with its fixed measurement scheme will be implemented in clinical practice, including acute hospitals, rehabilitation facilities, outpatient centres and private practices. Various initiatives are under way. At 11 and 12 May 2020, an ESO Summer school on stroke rehabilitation will take place in Vienna, right before the joint ESO-WSO Conference held in the same city. Here, knowledge brokers will also be trained in the ESO-core set to enhance transparent intra- and inter-professional communication throughout the stroke rehabilitation pathway. In addition, steps are taken to implement the ESO-core set in national registries and provide regional trainings, starting in Switzerland.