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.