The Impact of Gender, Age, and Performance on Stroke Survivors' Goal Conceptualization, Prioritization, and Attainment


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ABSTRACT: Background: Stroke is a leading cause of disability in the United States. Current stroke rehabilitation recommendations include an emphasis on patient centered care and the inclusion of the stroke patient during goal setting and treatment planning. A better understanding of how stroke patients approach goals and prioritize outcomes would facilitate patient centered care. Methods: We utilized qualitative and quantitative methods to improve our understanding of goal priorities and goal attainment after stroke. First, we conducted interviews with 45 individuals who had sustained a stroke. Second, we evaluated gender differences in goal attainment in a large population based sample of stroke patients. During the interviews, subjects were asked to categorize and prioritize stroke goals as well as report on their current performance on these goals. The large population based sample was utilized to measure the likelihood of each gender accomplishing goals identified as important to them, and determining which patient characteristics impact goal attainment. Results: Stroke survivors categorized goals into similar groupings, without significant difference by age or gender. Goals that were most important to stroke survivors included improved balance, walking independently, feeding, and bathing. Many of the goals that were reported as important to stroke survivors, such as upper and lower extremity strength, balance, depression assistance and hand function are not measured in current required rehabilitation documentation. In the large population based study, women were more likely to discharge at a supervision level or better for all FIM™ items except stairs and upper extremity dressing. Individuals who lived alone prior to their stroke were more likely to discharge from rehab at a supervision level on each FIM™ item. Conclusion: Further research is needed, with a survey of a larger sample of individuals to get a better understanding of goal priorities after a stroke and determine if the gender and age differences seen here remain true. The large population based study indicates the gender differences seen in rehabilitation outcomes after stroke are most likely secondary to premorbid health and independence.



Stroke, Outcomes, Gender, Goals