The Effects Of "SMART" Rehabilitation Goals On The Activities Of Daily Living Of Patients With Stroke

Objective:This study intends to use randomized controlled trials to explore the impact of setting "SMART" rehabilitation goals on motor function,quality of life,and activities of daily living in stroke patients,and provide a basis for clinically using the "SMART" principle to set rehabilitation goals.Methods:86 eligible stroke patients were enrolled in a randomized controlled trial design,divided into the SMART group(43 patients)and the control group(43 patients).At the time of admission,the researchers performed a comprehensive baseline data measurement of the two groups of patients and conducted goal-related education for patients and their families.After the mission,the SMART group of patients and therapists conducted semi-structured interviews to allow patients to identify problems in the rehabilitation process and score their importance.Therapists and patients then selected the three most important questions.Then,follow the "SMART" principle of rehabilitation goals in accordance with the process of writing "SMART" rehabilitation goals(Specific,Measurable,Achievable,Realistic/Relevant,Timed).The therapist and the patient in the control group conducted interviews to determine the important problems of the patients,and then according to the conventional goal setting method,the therapist directly sets the rehabilitation target according to the evaluation result and the patient's target expectation.The rehabilitation goals of this group of patients did not meet the "SMART" principle.The researchers used the Fugl-Meyer assessment scale(FMA),Stroke Impact Scale(SIS)and Modified Barthel Index(MBI)to assess motor function,quality of life and ability of daily living at 1 month and 2 months after goal setting,respectively.Results:1.Baseline results showed that there were no statistically significant differences in general information(age,gender,cognitive level,degree of depression,education level,course of disease,medical payment method,stroke type)and indicators(MBI,FMA and SIS scales)between the two groups(P>0.05).2.The difference of MBI score between the SMART group and the control group was statistically significant after 1 month and 2 months of intervention(P<0.001).3.The difference of FMA scores between the two groups after 1 month and 2 months of intervention was statistically significant(P<0.001).4.The difference of SIS total score between the two groups after 1 month and 2 months of intervention was statistically significant(P<0.001).In the 8 dimensions of SIS,after one month of intervention,the differences in strength,movement,hand function and participation scores between the SMART group and the control group were statistically significant(P<0.001).In terms of the cognitive and ADL scores,only the difference in the SMART group were statistically significant(P?0.006),while the difference in emotion and communication were only statistically significant in the control group(P < 0.001).After 2 months of intervention,the difference between the SMART group and the control group was statistically significant(P?0.006),except for the ADL scores in SMART group(P=0.007).5.Linear mixed model analysis results showed that the MBI score(P=0.035),SIS total score(P=0.012)and SIS-participation dimension(P=0.002)in the SMART group were significantly higher than those in the control group,with significant group×time effect.The FMA score(P=0.018),SIS-strength dimension(P=0.006),and the SIS-cognition dimension(P=0.004)had significant group effects,and the SMART group was larger than the control group.Conclusion:1.Setting "SMART" rehabilitation goals can improve motor function,quality of life and activities of daily living of stroke patients.2.Setting "SMART" rehabilitation goals to improve the quality of life of stroke patients may be through affecting the participation,cognitive level and physical strength of stroke patients.