Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel

Jessica Nolan; Angela Jacques; Erin Godecke; Hiroaki Abe; Suzanne Babyar; Jeannine Bergmann; Melissa Birnbaum; Shenhao Dai; Cynthia Danells; Taiza Gs Edwards; Marialuisa Gandolfi; Klaus Jahn; Ryan Koter; Avril Mansfield; Junji Nakamura; Vicky Pardo; Dominic Perennou; Celine Piscicelli; David Punt; Devra Romick-Sheldon; Wim Saeys; Nicola Smania; Nathalie Vaes; Abigail L Whitt; Barbara Singer

doi:10.1177/02692155231172012

Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel

Jessica Nolan, Angela Jacques, Erin Godecke, Hiroaki Abe, Suzanne Babyar, Jeannine Bergmann, Melissa Birnbaum, Shenhao Dai, Cynthia Danells, Taiza Gs Edwards, Marialuisa Gandolfi, Klaus Jahn, Ryan Koter, Avril Mansfield, Junji Nakamura, Vicky Pardo, Dominic Perennou, Celine Piscicelli, David Punt, Devra Romick-SheldonWim Saeys, Nicola Smania, Nathalie Vaes, Abigail L Whitt, Barbara Singer

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

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Abstract

OBJECTIVE: People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel.

DESIGN: This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations.

PARTICIPANTS: Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion.

MAIN MEASURES: The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses.

RESULTS: Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded.

CONCLUSIONS: These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.

Original language	English
Pages (from-to)	1559-1574
Number of pages	16
Journal	Clinical Rehabilitation
Volume	37
Issue number	11
DOIs	https://doi.org/10.1177/02692155231172012
Publication status	Published - Nov 2023

Bibliographical note

Funding Information:
The author(s) received no financial support for the research, authorship, and/or publication of this article: This study was supported by a Raine Medical Research Foundation/Western Australian Department of Health Clinician Research Fellowship (CRF04-R9), the Charlies Foundation for Research (RAC 2020-21-021) and an Australian Government Research Training Programme Scholarship

Publisher Copyright:
© The Author(s) 2023.

Keywords

Delphi Technique
lateropulsion
pusher behaviour
pusher syndrome
stroke rehabilitation

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10.1177/02692155231172012Licence: CC BY-NC

Nolan ea 2023_Clin Rehab_Clin-practice-recomm-for-management-of-lateropulsion-after-stroke-by-a-Delphi-expert-panelFinal published version, 904 KBLicence: CC BY-NC

Cite this

Nolan, J., Jacques, A., Godecke, E., Abe, H., Babyar, S., Bergmann, J., Birnbaum, M., Dai, S., Danells, C., Edwards, T. G., Gandolfi, M., Jahn, K., Koter, R., Mansfield, A., Nakamura, J., Pardo, V., Perennou, D., Piscicelli, C., Punt, D., ... Singer, B. (2023). Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel. Clinical Rehabilitation, 37(11), 1559-1574. https://doi.org/10.1177/02692155231172012

Nolan, Jessica ; Jacques, Angela ; Godecke, Erin ; Abe, Hiroaki ; Babyar, Suzanne ; Bergmann, Jeannine ; Birnbaum, Melissa ; Dai, Shenhao ; Danells, Cynthia ; Edwards, Taiza Gs ; Gandolfi, Marialuisa ; Jahn, Klaus ; Koter, Ryan ; Mansfield, Avril ; Nakamura, Junji ; Pardo, Vicky ; Perennou, Dominic ; Piscicelli, Celine ; Punt, David ; Romick-Sheldon, Devra ; Saeys, Wim ; Smania, Nicola ; Vaes, Nathalie ; Whitt, Abigail L ; Singer, Barbara. / Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel. In: Clinical Rehabilitation. 2023 ; Vol. 37, No. 11. pp. 1559-1574.

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title = "Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel",

abstract = "OBJECTIVE: People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel.DESIGN: This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations.PARTICIPANTS: Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion.MAIN MEASURES: The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses.RESULTS: Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded.CONCLUSIONS: These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.",

keywords = "Delphi Technique, lateropulsion, pusher behaviour, pusher syndrome, stroke rehabilitation",

author = "Jessica Nolan and Angela Jacques and Erin Godecke and Hiroaki Abe and Suzanne Babyar and Jeannine Bergmann and Melissa Birnbaum and Shenhao Dai and Cynthia Danells and Edwards, {Taiza Gs} and Marialuisa Gandolfi and Klaus Jahn and Ryan Koter and Avril Mansfield and Junji Nakamura and Vicky Pardo and Dominic Perennou and Celine Piscicelli and David Punt and Devra Romick-Sheldon and Wim Saeys and Nicola Smania and Nathalie Vaes and Whitt, {Abigail L} and Barbara Singer",

note = "Funding Information: The author(s) received no financial support for the research, authorship, and/or publication of this article: This study was supported by a Raine Medical Research Foundation/Western Australian Department of Health Clinician Research Fellowship (CRF04-R9), the Charlies Foundation for Research (RAC 2020-21-021) and an Australian Government Research Training Programme Scholarship Publisher Copyright: {\textcopyright} The Author(s) 2023.",

year = "2023",

month = nov,

doi = "10.1177/02692155231172012",

language = "English",

volume = "37",

pages = "1559--1574",

journal = "Clinical Rehabilitation",

issn = "0269-2155",

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Nolan, J, Jacques, A, Godecke, E, Abe, H, Babyar, S, Bergmann, J, Birnbaum, M, Dai, S, Danells, C, Edwards, TG, Gandolfi, M, Jahn, K, Koter, R, Mansfield, A, Nakamura, J, Pardo, V, Perennou, D, Piscicelli, C, Punt, D, Romick-Sheldon, D, Saeys, W, Smania, N, Vaes, N, Whitt, AL & Singer, B 2023, 'Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel', Clinical Rehabilitation, vol. 37, no. 11, pp. 1559-1574. https://doi.org/10.1177/02692155231172012

Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel. / Nolan, Jessica; Jacques, Angela; Godecke, Erin; Abe, Hiroaki; Babyar, Suzanne; Bergmann, Jeannine; Birnbaum, Melissa; Dai, Shenhao; Danells, Cynthia; Edwards, Taiza Gs; Gandolfi, Marialuisa; Jahn, Klaus; Koter, Ryan; Mansfield, Avril; Nakamura, Junji; Pardo, Vicky; Perennou, Dominic; Piscicelli, Celine; Punt, David; Romick-Sheldon, Devra; Saeys, Wim; Smania, Nicola; Vaes, Nathalie; Whitt, Abigail L; Singer, Barbara.

In: Clinical Rehabilitation, Vol. 37, No. 11, 11.2023, p. 1559-1574.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel

AU - Nolan, Jessica

AU - Jacques, Angela

AU - Godecke, Erin

AU - Abe, Hiroaki

AU - Babyar, Suzanne

AU - Bergmann, Jeannine

AU - Birnbaum, Melissa

AU - Dai, Shenhao

AU - Danells, Cynthia

AU - Edwards, Taiza Gs

AU - Gandolfi, Marialuisa

AU - Jahn, Klaus

AU - Koter, Ryan

AU - Mansfield, Avril

AU - Nakamura, Junji

AU - Pardo, Vicky

AU - Perennou, Dominic

AU - Piscicelli, Celine

AU - Punt, David

AU - Romick-Sheldon, Devra

AU - Saeys, Wim

AU - Smania, Nicola

AU - Vaes, Nathalie

AU - Whitt, Abigail L

AU - Singer, Barbara

N1 - Funding Information: The author(s) received no financial support for the research, authorship, and/or publication of this article: This study was supported by a Raine Medical Research Foundation/Western Australian Department of Health Clinician Research Fellowship (CRF04-R9), the Charlies Foundation for Research (RAC 2020-21-021) and an Australian Government Research Training Programme Scholarship Publisher Copyright: © The Author(s) 2023.

PY - 2023/11

Y1 - 2023/11

N2 - OBJECTIVE: People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel.DESIGN: This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations.PARTICIPANTS: Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion.MAIN MEASURES: The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses.RESULTS: Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded.CONCLUSIONS: These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.

AB - OBJECTIVE: People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel.DESIGN: This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations.PARTICIPANTS: Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion.MAIN MEASURES: The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses.RESULTS: Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded.CONCLUSIONS: These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.

KW - Delphi Technique

KW - lateropulsion

KW - pusher behaviour

KW - pusher syndrome

KW - stroke rehabilitation

U2 - 10.1177/02692155231172012

DO - 10.1177/02692155231172012

M3 - Article

C2 - 37122265

VL - 37

SP - 1559

EP - 1574

JO - Clinical Rehabilitation

JF - Clinical Rehabilitation

SN - 0269-2155

IS - 11

ER -

Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel

Abstract

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Keywords

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