Clinical Outcome Assessments for Functional Performance in Spastic Paresis: Systematic Review, Critique, and Recommendations

BACKGROUND: Spastic paresis, resulting from central nervous system lesions, significantly impairs functional performance. In the framework of the International Classification of Functioning, Disability, and Health, functional performance was defined as functioning at the activity level in relation to the impairment of body functions and structures, that is, symptoms of spastic paresis syndrome. Reliable clinical outcome assessments (COAs) for functional performance evaluation are needed. OBJECTIVE: This systematic review evaluates the clinimetric properties of functional performance COAs in spastic paresis and provides recommendations for their use. METHODS: A literature search identified relevant COAs, which were systematically assessed by an international expert panel and classified as "recommended," "recommended with caveats," "suggested," or "listed" following the Movement Disorder Society-COA methodology. RESULTS: Seventy-one COAs were identified, and 14 COAs used in over 2% of studies were reviewed. Five COAs assessing lower limb functional performance met the "recommended" criteria, whereas none of the upper limb COAs met the criteria for "recommended." Two upper-limb COAs were evaluated as "recommended with caveats." CONCLUSIONS: Two variants of the 10-Meter Walk Test, along with the 2-Minute or 6-Minute Walk Test (to account for fatigability), are recommended for assessing lower limb functional performance in patients with spastic paresis. The Wisconsin Gait Scale is recommended, although its clinical feasibility is limited. For the upper limb, the 13-item Arm Motor Ability Test and the Modified Frenchay Scale are classified as "recommended with caveats" because of identified limitations. Establishing consistent scoring guidelines and standardized protocols will be essential to enhance their clinical applicability and diffusion. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.