Individualized goals expressed by patients undergoing stroke rehabilitation: an observational study
DOI:
https://doi.org/10.2340/jrm.v56.15305Keywords:
goals, International Classification of Functioning, Disability, and Health (ICF), Patient-Specific Functional Scale (PSFS), rehabilitation, strokeAbstract
Objectives: To explore the rehabilitation goals measured with the Patient-Specific Functional Scale (PSFS) in patients undergoing acute and subacute stroke rehabilitation. In addition, to assess whether PSFS goals corresponded to impairments and activity limitations, as identified by standardized measures.
Design: Observational study.
Participants: A total of 71 participants undergoing inpatient stroke rehabilitation.
Methods: The PSFS goals were linked to second-level categories in the International Classification of Functioning, Disability and Health (ICF), using established linking rules. Frequencies of the linked ICF categories were calculated. Frequencies of participants with limitations in walking, activities of daily living (ADL), vision, language, and cognition, were calculated, along with goals in corresponding areas of functioning.
Results: The participants’ goals were linked to 50 second-level ICF categories, comprising areas such as walking and moving, ADL, language, vision, and cognition. The most frequent ICF categories were “Moving around in different locations” (n = 24), “Walking” (n = 23), “Toileting” (n = 16), “Hand and arm use (n = 12) and “Fine hand use (n = 12)”. Of participants with limitations in walking, cognition, and vision, 85%, 10%, and 16%, respectively, had goals in these areas.
Conclusion: Participants’ goals included walking, ADL, language, vision, and cognition. Few with impairments in cognition or vision had goals in these corresponding areas on the PSFS.
Downloads
References
Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lan-cet Neurol 2021; 20: 795–820.
https://doi.org/10.1016/s1474-4422(21)00252-0 DOI: https://doi.org/10.1016/S1474-4422(21)00252-0
Louie DR, Simpson LA, Mortenson WB, Field TS, Yao J, Eng JJ. Prevalence of walking limitation after acute stroke and its impact on discharge to home. Phys Ther 2022; 102.
https://doi.org/10.1093/ptj/pzab246 DOI: https://doi.org/10.1093/ptj/pzab246
Wade DT, Hewer RL. Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry 1987; 50: 177–182.
https://doi.org/10.1136/jnnp.50.2.177 DOI: https://doi.org/10.1136/jnnp.50.2.177
Flowers HL, Skoretz SA, Silver FL, Rochon E, Fang J, Flamand-Roze C, et al. Poststroke aphasia frequency, recovery, and outcomes: a systematic review and meta-analysis. Arch Phys Med Rehabil 2016; 97: 2188–2201.
https://doi.org/10.1016/j.apmr.2016.03.006 DOI: https://doi.org/10.1016/j.apmr.2016.03.006
McClure JA, Salter K, Foley N, Mahon H, Teasell R. Adherence to Canadian Best Practice Recommendations for Stroke Care: vascular cognitive im-pairment screening and assessment practices in an Ontario inpatient stroke rehabilitation facility. Top Stroke Rehabil 2012; 19: 141–148.
https://doi.org/10.1310/tsr1902-141 DOI: https://doi.org/10.1310/tsr1902-141
Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2016; 47: e98–e169.
https://doi.org/10.1161/str.0000000000000098 DOI: https://doi.org/10.1161/STR.0000000000000098
Rowe FJ, Hepworth LR, Howard C, Hanna KL, Cheyne CP, Currie J. High incidence and prevalence of visual problems after acute stroke: an epidemio-logy study with implications for service delivery. PLoS One 2019; 14: e0213035.
https://doi.org/10.1371/journal.pone.0213035 DOI: https://doi.org/10.1371/journal.pone.0213035
World Health Organization. Rehabilitation in health systems. Geneva: World Health Organization; 2017. report no.: 978-92-4-154997-4,.
Knutti K, Björklund Carlstedt A, Clasen R, Green D. Impacts of goal setting on engagement and rehabilitation outcomes following acquired brain injury: a systematic review of reviews. Disabil Rehabil 2022; 44: 2581–2590.
https://doi.org/10.1080/09638288.2020.1846796 DOI: https://doi.org/10.1080/09638288.2020.1846796
Sugavanam T, Mead G, Bulley C, Donaghy M, van Wijck F. The effects and experiences of goal setting in stroke rehabilitation – a systematic review. Disabil Rehabil 2013; 35: 177–190.
https://doi.org/10.3109/09638288.2012.690501 DOI: https://doi.org/10.3109/09638288.2012.690501
Moore JL, Potter K, Blankshain K, Kaplan SL, O’Dwyer LC, Sullivan JE. A Core Set of outcome measures for adults with neurologic conditions undergoing rehabilitation: a clinical practice guideline. J Neurol Phys Ther 2018; 42: 174–220.
https://doi.org/10.1097/npt.0000000000000229 DOI: https://doi.org/10.1097/NPT.0000000000000229
Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns 2017; 100: 65–75.
https://doi.org/10.1016/j.pec.2016.07.030 DOI: https://doi.org/10.1016/j.pec.2016.07.030
Taylor-Rowan M, Wilson A, Dawson J, Quinn TJ. Functional assessment for acute stroke trials: properties, analysis, and application. Front Neurol 2018; 9: 191.
https://doi.org/10.3389/fneur.2018.00191 DOI: https://doi.org/10.3389/fneur.2018.00191
Stevens A, Beurskens A, Koke A, van der Weijden T. The use of patient-specific measurement instruments in the process of goal-setting: a systematic review of available instruments and their feasibility. Clin Rehabil 2013; 27: 1005–1019.
https://doi.org/10.1177/0269215513490178 DOI: https://doi.org/10.1177/0269215513490178
Stratford P, Gill C, Westaway M, Binkley J. Assessing disability and change on individual patients: a report of a patient specific measure. 1995; 47 258–263.
https://doi.org/10.3138/ptc.47.4.258 DOI: https://doi.org/10.3138/ptc.47.4.258
Valaas HL, Klokkerud M, Hildeskår J, Hagland AS, Kjønli E, Mjøsund K, et al. Rehabilitation goals described by patients with rheumatic and musculoske-letal diseases: content and attainment during the first year after rehabilitation. Disabil Rehabil 2022; 44: 7947–7957.
https://doi.org/10.1080/09638288.2021.2003879 DOI: https://doi.org/10.1080/09638288.2021.2003879
Storløs B, Roaldsen KS, Soberg HL, Kleffelgaard I. Patient-specific functioning related to dizziness and balance problems after traumatic brain injury – a cross sectional study using an ICF perspective. Cogent medicine 2021; 8: 1932247.
https://doi.org/10.1080/2331205X.2021.1932247 DOI: https://doi.org/10.1080/2331205X.2021.1932247
Røe Y, Rysstad T, Tveter AT, Sandbakk TB, Jæger M, Grotle M. What are the most important problems in functioning among patients with shoulder pain? An analysis of the patient-specific functional scale. Phys Ther 2021; 101: pzab141.
https://doi.org/10.1093/ptj/pzab141 DOI: https://doi.org/10.1093/ptj/pzab141
Rice DB, McIntyre A, Mirkowski M, Janzen S, Viana R, Britt E, et al. Patient-centered goal setting in a hospital-based outpatient stroke rehabilitation center. PM R 2017; 9: 856–865.
https://doi.org/10.1016/j.pmrj.2016.12.004 DOI: https://doi.org/10.1016/j.pmrj.2016.12.004
Harris JE, Eng JJ. Goal priorities identified through client-centred measurement in individuals with chronic stroke. Physiother Can 2004; 56: 171–176.
https://doi.org/10.2310/6640.2004.00017 DOI: https://doi.org/10.2310/6640.2004.00017
Evensen J, Soberg HL, Sveen U, Hestad KA, Moore JL, Bronken BA. Measurement properties of the patient-specific functional scale in rehabilitation for patients with stroke: a prospective observational study. Phys Ther 2023; 10.1093/ptj/pzad014.
https://doi.org/10.1093/ptj/pzad014 DOI: https://doi.org/10.1093/ptj/pzad014
Nasreddine Z. MoCA Montreal Cognitive Assessment. 2021 [cited 2023 Dec 10]. Available from: https://www.mocatest.org/faq/
Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, et al. Agreed definitions and a shared vision for new standards in stroke reco-very research: The Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke 2017; 12: 444–450.
https://doi.org/10.1177/1747493017711816 DOI: https://doi.org/10.1177/1747493017711816
World Health Organization. World Health Organization. International Classification of Function Disability and Health: ICF. 2001 [cited 2023 Jan 20] Avai-lable from: https://www.who.int/classifications/icf/en/
Cieza A, Fayed N, Bickenbach J, Prodinger B. Refinements of the ICF Linking rules to strengthen their potential for establishing comparability of health information. Disabil Rehabil 2019; 41: 574–583.
https://doi.org/10.3109/09638288.2016.1145258 DOI: https://doi.org/10.3109/09638288.2016.1145258
Modernized International Classification of Functioning, Disability and Health (ICF) online browser [database on the internet]. 2022. [Cited 2022 Aug 04] Available from: https://icd.who.int/dev11/l-icf/en.
Heldmann P, Hummel S, Bauknecht L, Bauer JM, Werner C. Construct validity, test-retest reliability, sensitivity to change, and feasibility of the patient-specific functional scale in acutely hospitalized older patients with and without cognitive impairment. J Geriatr Phys Ther 2022; 45: 134–144.
https://doi.org/10.1519/jpt.0000000000000303 DOI: https://doi.org/10.1519/JPT.0000000000000303
Ellis C, Focht KL, Grubaugh AL. Perceptions of stroke recovery: an exclusion of communication and cognition. NeuroRehabilitation 2013; 33: 233–239.
https://doi.org/10.3233/nre-130950 DOI: https://doi.org/10.3233/NRE-130950
Middleton A, Fritz SL, Lusardi M. Walking speed: the functional vital sign. J Aging Phys Act 2015; 23: 314–322.
https://doi.org/10.1123/japa.2013-0236 DOI: https://doi.org/10.1123/japa.2013-0236
Waddell KJ, Birkenmeier RL, Bland MD, Lang CE. An exploratory analysis of the self-reported goals of individuals with chronic upper-extremity paresis following stroke. Disabil Rehabil 2016; 38: 853–857.
https://doi.org/10.3109/09638288.2015.1062926 DOI: https://doi.org/10.3109/09638288.2015.1062926
Evensen J, Soberg HL, Sveen U, Hestad KA, Bronken BA. The applicability of the Patient-Specific Functional Scale (PSFS) in rehabilitation for patients with acquired brain injury (ABI) – a cohort study. J Multidiscip Healthc 2020; 13: 1121–1132.
https://doi.org/10.2147/jmdh.S259151 DOI: https://doi.org/10.2147/JMDH.S259151
Tarvonen-Schröder S, Hurme S, Laimi K. The World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the WHO Minimal Generic Set of Domains of Functioning and Health versus Conventional Instruments in subacute stroke. J Rehabil Med 2019; 51: 675–682.
https://doi.org/10.2340/16501977-2583 DOI: https://doi.org/10.2340/16501977-2583
Patchick EL, Horne M, Woodward-Nutt K, Vail A, Bowen A. Development of a patient-centred, patient-reported outcome measure (PROM) for post-stroke cognitive rehabilitation: qualitative interviews with stroke survivors to inform design and content. Health Expect 2015; 18: 3213–3224.
https://doi.org/10.1111/hex.12311 DOI: https://doi.org/10.1111/hex.12311
Culler KH, Wang YC, Byers K, Trierweiler R. Barriers and facilitators of return to work for individuals with strokes: perspectives of the stroke survivor, vocational specialist, and employer. Topics Stroke Rehabil 2011; 18: 325–340.
https://doi.org/10.1310/tsr1804-325 DOI: https://doi.org/10.1310/tsr1804-325
Hepworth LR, Howard C, Hanna KL, Currie J, Rowe FJ. “Eye” don’t see: an analysis of visual symptom reporting by stroke survivors from a large epide-miology study. J Stroke Cerebrovasc Dis 2021; 30: 105759.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105759 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105759
Falkenberg HK, Mathisen TS, Ormstad H, Eilertsen G. “Invisible” visual impairments. A qualitative study of stroke survivors’ experience of vision symptoms, health services and impact of visual impairments. BMC Health Serv Res 2020; 20: 302.
https://doi.org/10.1186/s12913-020-05176-8 DOI: https://doi.org/10.1186/s12913-020-05176-8
Berthold-Lindstedt M, Johansson J, Ygge J, Borg K. How to assess visual function in acquired brain injury – asking is not enough. Brain Behav 2021; 11: e01958.
https://doi.org/10.1002/brb3.1958 DOI: https://doi.org/10.1002/brb3.1958
Rankin J. Cerebral vascular accidents in patients over the age of 60. III. Diagnosis and treatment. Scott Med J 1957; 2: 254–268. DOI: https://doi.org/10.1177/003693305700200604
https://doi.org/https://doi.org/10.1177/003693305700200504 DOI: https://doi.org/10.1177/003693305700200504
Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil 2007; 88: 1314–1319.
https://doi.org/10.1016/j.apmr.2007.06.764 DOI: https://doi.org/10.1016/j.apmr.2007.06.764
Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J 1965; 14: 61–65. DOI: https://doi.org/10.1037/t02366-000
Brott T, Adams HP, Jr., Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20: 864–870.
https://doi.org/10.1161/01.str.20.7.864 DOI: https://doi.org/10.1161/01.STR.20.7.864
Kagan A, Winckel J, Black S, Duchan JF, Simmons-Mackie N, Square P. A set of observational measures for rating support and participation in conver-sation between adults with aphasia and their conversation partners. Topics Stroke Rehabil 2004; 11: 67–83.
https://doi.org/10.1310/cl3v-a94a-de5c-cvbe DOI: https://doi.org/10.1310/CL3V-A94A-DE5C-CVBE
Toglia J, Fitzgerald KA, O’Dell MW, Mastrogiovanni AR, Lin CD. The Mini-Mental State Examination and Montreal Cognitive Assessment in persons with mild subacute stroke: relationship to functional outcome. Archives Phys Med Rehabil 2011; 92: 792–798.
https://doi.org/10.1016/j.apmr.2010.12.034 DOI: https://doi.org/10.1016/j.apmr.2010.12.034
Munthe-Kaas R, Aam S, Saltvedt I, Wyller TB, Pendlebury ST, Lydersen S, et al. Test accuracy of the montreal cognitive assessment in screening for early poststroke neurocognitive disorder: the Nor-COAST Study. Stroke 2021; 52: 317–320.
https://doi.org/10.1161/strokeaha.120.031030 DOI: https://doi.org/10.1161/STROKEAHA.120.031030
Published
How to Cite
License
Copyright (c) 2024 Janne Evensen, Helene Lundgaard Soberg, Unni Sveen, Knut A. Hestad, Jennifer L. Moore, Berit Arnesveen Bronken
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
