Measurement Properties of the Patient-Specific Functional Scale in Rehabilitation for Patients With Stroke: A Prospective Observational Study.
Janne Evensen, Helene Lundgaard Soberg, Unni Sveen and 3 others
PMID 37140476WHAT IT FOUND
The Patient-Specific Functional Scale works well for tracking patient goals during inpatient stroke rehabilitation, even when patients have cognitive or language impairments.
A change of at least 2 points indicates real improvement beyond measurement error. However, the scale becomes less useful after discharge as patients hit a ceiling.
Key findings
01The scale demonstrated satisfactory content validity, with 80% of patient-identified goals mapping to activity and participation domains.
02A change score of 1.58 points was identified as the minimal important change, but a threshold of 2.0 points is recommended to account for measurement error (SDC95 = 1.94).
03Responsiveness was high during inpatient stay but low at 3-month follow-up, with 25% of participants scoring the maximum 10 points, indicating a ceiling effect.
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 had a small sample size, particularly for the subgroup analyses of responsiveness (20 stable, 50 improved). Data collection was disrupted by the COVID-19 pandemic, leading to a mix of in-person and telephone assessments at follow-up, which may introduce bias. The ceiling effect at 3 months limits the utility of the same PSFS items for long-term monitoring without re-setting goals. Participants were excluded if they could not speak Norwegian or had severe aphasia, so results may not generalize to patients with more severe communication barriers.
Declared interests
The funders (Innlandet Hospital Trust) had no role in the study's design, conduct, or reporting.
The easy way to misread this
Do not assume the PSFS will continue to detect improvement at 3 months post-discharge using the same items. The study found low responsiveness and a ceiling effect at this stage, meaning patients may score 10/10 not because they have no further potential, but because their initial goals are too easy.