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Evaluating and improving care

Lower limb function

Development of tools to assess function in the spastic lower limb

Through related work the need for further assessment of lower limb function has been identified. Assessing functional gain is problematic for three reasons. Firstly the goals for treatment vary widely (Sheean 2001). Secondly in some cases treatment is aimed at restoring motor control leading to independent function (termed ‘active function’). Thirdly in other cases, where paralysis is more severe, the goals for intervention may be to improve the ease of caring for the person - maintaining hygiene or ease of dressing for example (termed ‘passive function’). The management of spasticity also includes physiotherapy to stretch the affected muscles and where possible to promote motor control through practice of tasks, and is therefore further complicated by incorporating more than one intervention. 

While functional scales, which include a standardised task battery, are useful for comparison of different patient groups, they may not reflect accurately the individual goals of each patient, and user-focused outcomes are increasingly regarded as critical to the demonstration of success. There is therefore a need to develop functional outcome measurement tools to use alongside approaches such as Goal Attainment Scaling, which assess both active and passive function from the ecological perspective of the "patient".

Main Projects

Work has been undertaken including funded by an NIHR Clinical Lectureship award to Dr Stephen Ashford. Work has so far included, a systematic review, identify pre-existing tools, which may be valuable in this area of outcome measurement and systematically reviewing our pre-existing database of intervention for this patient group. Current research outputs being developed include:

  • A Patient Reported Outcome Measure (PROM) questionnaire:
  • Development of lower limb proformas for outcome evaluation
  • Systems for recording therapy intervention
  • Costing models for lower limb spasticity intervention


Ashford S, Brown S, Turner-Stokes L. (2015) Systematic review of patient-reported outcome measures for functional performance in the lower limb. J Rehabil Med. 47(1):9-17. doi: 10.2340/16501977-1889. 

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