Decision-making aids for upper limb interventions in neurological rehabilitation: a scoping review

Abstract

Purpose

To summarise the range and nature of decision-making aids that guide upper limb (UL) neurorehabilitation.

Methods

Our scoping review followed Arksey and O’Malley’s 6-step framework. Electronic databases were systematically searched; grey literature was hand-searched. Included papers were: (1) published in English; (2) related to UL rehabilitation for people with upper motor neuron conditions; and (3) provided a description of, or research on, a decision-making aid that guides therapists when choosing between two or more intervention approaches, techniques, or applications of a technique. Levels of evidence were rated. An expert panel of occupational therapists working in UL neurorehabilitation was consulted.

Results

The 24 included articles described 15 decision-making aids with varying breadth and depth of the assessment process and suggested interventions. Six aids had published research, but lacked high quality evidence. The expert panel identified four key decision-making aids as being clinically useful. Preferred aids either included client-centred goal-setting within a holistic assessment or matched specific intervention options to distinct UL assessment results. Prompts to re-evaluate client performance are desirable.

Conclusion

Few decision-making aids guide therapists to holistically assess and make specific intervention decisions across all domains of UL neurorehabilitation. Their usefulness depends on the purpose, setting, and therapist experience.

Implications for rehabilitation

• Considering the complexity and heterogeneity of upper limb (UL) neurorehabilitation, a selection of evidence-based and purpose-designed decision-making aids may assist therapists across different experience levels and practice settings to choose individualised interventions.

• Decision-making aids for UL interventions in neurorehabilitation may be more clinically useful if they include a holistic and client-centred information gathering process that focuses on daily life goals.

• Decision-making aids should illustrate a clear clinical picture based on UL assessment results, with corresponding UL intervention recommendations provided.

• Inclusion of a cyclic process to re-evaluate client performance and function could also enhance the usefulness of a decision-making aid.

Keywords:

• Brain injuries
• cerebral palsy
• clinical decision-making
• occupational therapy
• stroke
• upper extremity

Ethical approval

We incorporated an expert consultation in our scoping review. Ethics approval was obtained through The University of Queensland Human Research Ethics Committee (Approval number 2018000509) prior to commencement of the consultations.

Acknowledgements

The authors would like to thank Marcos Riba, the librarian for the School of Health and Rehabilitation Sciences, The University of Queensland for assisting us with the search strategy. This scoping review was completed as part of the first author’s PhD candidature, which is supported by a UQ Graduate School Scholarship.

Disclosure statement

No potential conflict of interest was reported by the author(s).