REhabilitation Arm Clinical pracTice (REACT). Development of a Delphi-based survey on clinical practice in upper limb rehabilitation after stroke

Autori

Rossi Federica [Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy]

Amadei Maurizio [Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy]

Vetere Andrea [Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy]

Caronni Antonio [Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy – Department of Biomedical Sciences for Health, University of Milan, Milan, Italy]

Perucca Laura [Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy – Department of Biomedical Sciences for Health, University of Milan, Milan, Italy]

Background and aims

Upper limb motor recovery after stroke remains one of the most challenging and heterogeneously managed aspects of neurorehabilitation. Clinical experience suggests that physiotherapists often recognize a discrepancy between what is considered optimal care and what is implemented in routine clinical practice [1]. Difficulties in achieving meaningful functional recovery, variability in clinical approaches, and uncertainty about the most effective treatment strategies highlight the complexity of upper limb rehabilitation and the need for greater clarity and consistency [2]. Although numerous guidelines exist, real-world practice, clinical reasoning, and professional perspectives are still poorly defined [3]. The REACT project explores current practice, beliefs, and challenges to identify areas for improvement and innovation.

Methods

REACT will adopt a modified two-step Delphi-based methodology involving panels of expert physiotherapists and multidisciplinary rehabilitation specialists.

• Formation of a steering workgroup responsible for study coordination, panel selection, and thematic scope and areas.
• Recruitment of a first panel (Panel 1), who will participate in structured meetings to generate survey statements. Thematic areas include clinical assessment, clinical conditions, rehabilitation interventions, physical modalities, planning and delivery of care, intensity of rehabilitation, drugs, team composition, and prognosis.
• Recruitment of a second panel (Panel 2) to rate and validate the statements produced by Panel 1 for relevance, clarity, and appropriateness using Likert-scale evaluations.
• Final selection of ~30 core items to construct the definitive survey.

The workgroup will oversee data processing, duplicate removal, content validation, and thematic coverage analysis between Delphi rounds.

The final version of the survey will be disseminated through the official channels and professional networks of AIFI (Associazione Italiana di Fisioterapia) to ensure a broad national reach and optimal engagement among practising physiotherapists.

The protocol will undergo ethics committee approval before administering the survey .

Results

The project will develop a survey designed to reflect current physiotherapy practice in upper limb stroke rehabilitation accurately. The findings will identify dominant approaches, underused interventions, and perceived barriers.

Results will be shared through peer-reviewed publications, professional society channels (e.g., AIFI), and scientific conferences.

Conclusion

The REACT Survey serves as a structured starting point for exploring physiotherapy practice in upper limb stroke rehabilitation. By capturing routine clinical practice in upper limb rehabilitation following a stroke, REACT will enable the identification of needs and areas for development in research into this common and significant condition within physiotherapy practice.

REFERENCES

1. Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev. 2014 Nov 12;2014(11):CD010820. doi: 10.1002/14651858.CD010820.pub2. PMID: 25387001; PMCID: PMC6469541.
2. Hayward KS, Kramer SF, Thijs V, Ratcliffe J, Ward NS, Churilov L, Jolliffe L, Corbett D, Cloud G, Kaffenberger T, Brodtmann A, Bernhardt J, Lannin NA. A systematic review protocol of timing, efficacy and cost effectiveness of upper limb therapy for motor recovery post-stroke. Syst Rev. 2019 Jul 25;8(1):187. doi: 10.1186/s13643-019-1093-6. PMID: 31345263; PMCID: PMC6657039.
3. Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, Cen SY, Azen SP; Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Investigative Team. Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial. 2016 Feb 9;315(6):571-81. doi: 10.1001/jama.2016.0276. PMID: 26864411; PMCID: PMC4795962.