European Stroke Organisation (ESO) guideline on motor rehabilitation

Abstract

Motor rehabilitation aims to help people after stroke to gain optimal motor functioning, independence and quality of life. This European Stroke Organisation (ESO) guideline provides updated, evidence-based support for clinical practice in six agreed critical areas: dose for upper limb and gait therapy, high-intensity gait training, effect of therapy transfer package, group versus individual therapy and sit-to-stand training. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Expert consensus statements are provided where a GRADE recommendation cannot be made due to insufficient evidence. For therapy dose, very low quality evidence supports a weak recommendation to provide an additional minimal dose of 20 h of repetitive upper limb practice to improve arm capacity. For gait, expert consensus suggests that an additional minimal dose of 20 h of walking practice could be beneficial for walking capacity. For high-intensity gait training, moderate quality evidence supports a strong recommendation for high-intensity gait training to improve walking endurance in people with chronic stroke and stable cardiovascular status, while low quality evidence supports a weak recommendation for improving walking speed. An expert consensus suggests using a transfer package when providing upper limb task-specific training to enhance transfer to daily life. For group therapy, a weak recommendation based on very low quality evidence suggests that task-specific group-based therapy is non-inferior to individual therapy for improving balance, gait speed and walking endurance. A weak recommendation based on moderate quality evidence suggests additional sit-to-stand training to improve balance.

Keywords: Guideline; dosage; gait; intensity; lower limb; motor rehabilitation; stroke; upper limb; walking.

Graphical abstract

Figure 1.

(a; top). Risk of bias for PICO 1 Action Research Arm Test outcome; (b; bottom). Forest plot of meta-analysis for Action Research Arm Test in PICO 1.

Figure 2.

(a; top). Risk of bias for PICO 3 comfortable walking speed outcome; (b; bottom). Forest plot of meta-analysis for comfortable walking speed in PICO 3.

Figure 3.

(a; top). Risk of bias for PICO 3 maximum walking speed outcome; (b; bottom). Forest plot of meta-analysis for maximum walking speed in PICO 3.

Figure 4.

(a; top) Risk of bias for PICO 3 6-Minute Walk Test outcome; (b; bottom) Forest plot of meta-analysis for 6-Minute Walk Test in PICO 3.

Figure 5.

(a; top). Risk of bias for PICO 5 Berg Balance Scale outcome; (b; bottom). Forest plot of meta-analysis for Berg Balance Scale in PICO 5. The blue line represents the non-inferiority margin.

Figure 6.

(a; top). Risk of bias for PICO 5 Timed Up and Go outcome; (b; bottom). Forest plot of meta-analysis for Timed Up and Go in PICO 5. The blue line represents the non-inferiority margin.

Figure 7.

(a; top) Risk of bias for PICO 5 Gait Speed outcome; (b; bottom) Forest plot of meta-analysis for Gait Speed in PICO 5. The blue line represents the non-inferiority margin.

Figure 8.

(a; top) Risk of bias for PICO 5 6-Minute Walk Test outcome; (b; bottom) Forest plot of meta-analysis for 6-Minute Walk Test in PICO 5. The blue line represents the non-inferiority margin.

Figure 9.

(a; top) Risk of bias for PICO 6 Berg Balance Scale outcome; (b; bottom) Forest plot of meta-analysis for Berg Balance Scale in PICO 6.