The only goal in stroke is 100% recovery, your advisor failed you in allowing the tyranny of low expectations to infect your thesis.
The Patient-Specific Functional Scale (PSFS) for measuring rehabilitation goals for patients with stroke
Abstract
Background: Approximately 10,000 people are hospitalized due to a
stroke annually in Norway, often requiring multidisciplinary
rehabilitation. Goal-setting is an essential component of the
rehabilitation, with literature emphasizing the need for a measurement
to identify, document and monitor rehabilitation goals for patients with
stroke. The measurement Patient-Specific Functional Scale (PSFS)
appears suitable for this purpose, enabling patients to identify and
rate their challenges. However, its use in the stroke population has not
been explored.
Aim: To investigate the PSFS as a measurement to identify,
document and monitor patient-identified rehabilitation goals for
patients in specialized stroke rehabilitation by exploring the
applicability, validity, reliability, responsiveness, and
interpretability of the PSFS, and by exploring patients’ PSFS goals.
Methods: This thesis encompasses two prospective cohort studies
and one cross-sectional study, involving two separate samples. Paper I
included 59 patients with acquired brain injury (ABI) (92% with stroke).
Papers II and III included 71 patients with stroke. The 130
participants were admitted to a specialized rehabilitation unit for more
than 10 days. The PSFS was utilized in the development of
rehabilitation goals with a shared decision-making (SDM) approach. The
data collected included cognitive function, aphasia, vision, functional
independence, activities of daily living (ADL), ambulation, gait speed,
and perceived change in function. We calculated the proportion of
participants who could complete the PSFS, and the time spent on
identifying the rehabilitation goals and completion of the PSFS. The
COSMIN checklist guided the methods of analysis of the measurement
properties. The PSFS goals were linked to the International
Classification of Functioning, Disability and Health (ICF) categories,
and we calculated the number of times each ICF category was linked. We
also calculated the frequency of patients who set PSFS goals in the
functional areas of walking and mobility, ADL, language, cognition, and
vision.
Results: Fifty-four of 59 participants completed the PSFS, while
the five who were unable to complete it had severe aphasia or another
cognitive impairment. Nine participants admitted to the rehabilitation
unit in the acute phase were able to complete the PSFS. The average time
spent on developing rehabilitation goals and completing the PSFS was 28
minutes. Cognitive function was the main explanatory factor for changes
in the PSFS score, with patients of higher cognitive function showing
greater improvement. The mean PSFS score improved by 2.6 points from
admission to discharge, and by 1.2 points from discharge to the
three-month follow-up. Eighty percent of the PSFS goals were ICF
activities, indicating satisfactory content validity. Reliability was
satisfactory with an ICC95 of 0.81. The SEM was calculated to be 0.70
points, the SDC 1.94 points, and the MIC 1.58 points. The construct
validity was moderate and the responsiveness assessed with a construct
approach was high. Responsiveness assessed using a criterion approach
showed satisfactory responsiveness from admission to discharge but low
responsiveness from discharge to three months post-discharge. A ceiling
effect was observed in 25% of participants three months after discharge.
“Walking and moving” and “Self-care” were the most frequent PSFS goals.
Most participants with walking limitations set goals related to
walking, but few participants with cognitive or visual impairments set
goals in those areas of functioning. Only half of the ICF categories
linked from the PSFS goals corresponded to areas assessed by the
standardized measurement.
Conclusion: The findings indicate that the PSFS is an appropriate
tool for identifying, documenting, and monitoring rehabilitation goals
for patients in specialized stroke rehabilitation, when used in a SDM
approach.
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