Individualized goals expressed by patients undergoing stroke rehabilitation: an observational study.
Janne Evensen, Helene Lundgaard Soberg, Unni Sveen and 3 others
PMID 38226892WHAT IT FOUND
Stroke patients prioritized walking and daily tasks, but few set goals for cognitive or visual deficits despite having them.
Patient-specific goal measures capture functional activities well but may miss underlying impairments, so clinicians should ask about these areas directly rather than relying on scores.
Key findings
01Only half of the goal categories matched the areas assessed by standard stroke measures, indicating patient goals often address functions not captured by routine tests.
02Most patients with walking limitations set walking goals, but few patients with cognitive or visual impairments set goals in those areas, suggesting a mismatch between measured deficits and patient priorities.
03Patients who had no measured cognitive impairment still set cognitive goals, indicating that the severity of a limitation on a test does not determine whether a patient finds it important enough to set a goal.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study did not assess hand and arm function with a standardized measure, so it could not determine if goals related to handling objects matched actual physical limitations. Premorbid functioning was not recorded, meaning some impairments (like vision or cognition) may have existed before the stroke, complicating the link between stroke-related deficits and goals. The PSFS limits patients to five goals, which may have prevented them from listing goals in every area of impairment, though only 16% of patients used all five slots. Some goals were vaguely described, requiring researchers to infer the underlying problem from medical records, which could lead to incorrect categorization of goals related to reading, writing, or speaking.
Declared interests
The authors declared no conflicts of interest. The study was funded by Innlandet Hospital Trust, which played no role in the design, conduct, or reporting of the study.
The easy way to misread this
Do not interpret the low number of cognitive or visual goals as evidence that these impairments are unimportant to patients. The study suggests that patients may not identify these as goals because they focus on activities or lack awareness of the deficits, not because the impairments do not affect their recovery.