Ashford Stephen, Jacinto Jorge, Fheodoroff Klemens, Turner-Stokes Lynne
Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK.
Regional Hyper-Acute Rehabilitation Unit, Northwick Park Hospital, London North West University Healthcare, UK.
Adv Rehabil Sci Pract. 2025 Jun 19;14:27536351251343520. doi: 10.1177/27536351251343520. eCollection 2025 Jan-Dec.
Setting goals and planning treatment to attain those goals is often integral to rehabilitation practice, particularly when managing spasticity following stroke or other brain injury. Optimal treatment planning and provision using an algorithm based on mapping goals and treatments, may improve outcome.
We analysed goal setting and treatment interventions through secondary analysis of goals and related treatments from (a) the Leg Activity measure study, (b) Ankle Contracture data set and (c) the Upper Limb International Spasticity-III study. Total 1207 participants. Goal categories were defined and identified based on a previously published framework: Pain, Involuntary Movement, Contracture Prevention, Active Function (self-performance of tasks), passive function (secondary performance of tasks or personal care). Treatment intervention was then identified per goal category.
: Pain 302 (22%), Involuntary Movement 166 (12%), Contracture Prevention 208 (15%), Active Function 174 (13%), passive function 501 (37%). : Pain (Positioning the limb, serial casting), Involuntary Movement (Position the limb, Splinting), Contracture Prevention (Positioning the limb, serial casting, Shoulder support and slings, Splinting), Active Function (Positioning the limb, serial casting, shoulder supports and splinting), passive function (Positioning the limb, serial casting, shoulder supports and splinting). : Pain 117 (15%), Involuntary Movement 10 (1%), Contracture Prevention 139 (17%), Active Function 356 (44%), passive function 181 (22%). : Pain (Passive stretch, positioning), Involuntary Movement (Splinting), Contracture Prevention (Positioning, Orthotics, Task Practice), Active Function (Task Practice, Orthotics), passive function (Orthotics, Positioning).
Commonalities in goal categorisation were found in arm and leg. In these cohorts' task-practice interventions to improve active function (walking and transferring) were reported for leg but were not frequently reported for arm rehabilitation. It is suggested that improved treatment planning may result in greater and faster treatment goal attainment and better outcomes.
设定目标并规划治疗以实现这些目标通常是康复实践不可或缺的一部分，尤其是在管理中风或其他脑损伤后的痉挛时。使用基于目标与治疗映射的算法进行最佳治疗规划和实施，可能会改善治疗效果。
我们通过对以下三项研究中的目标及相关治疗进行二次分析，来分析目标设定和治疗干预措施：(a)腿部活动测量研究；(b)踝关节挛缩数据集；(c)上肢国际痉挛-III研究。总计1207名参与者。基于先前发表的框架定义并识别目标类别：疼痛、不自主运动、挛缩预防、主动功能（任务的自我执行）、被动功能（任务的辅助执行或个人护理）。然后针对每个目标类别确定治疗干预措施。
疼痛302例（22%），不自主运动166例（12%），挛缩预防208例（15%），主动功能174例（13%），被动功能501例（37%）。疼痛（肢体定位、系列石膏固定），不自主运动（肢体定位、夹板固定），挛缩预防（肢体定位、系列石膏固定、肩部支撑和吊带、夹板固定），主动功能（肢体定位、系列石膏固定、肩部支撑和夹板固定），被动功能（肢体定位、系列石膏固定、肩部支撑和夹板固定）。疼痛117例（15%），不自主运动10例（1%），挛缩预防139例（17%），主动功能356例（44%），被动功能181例（22%）。疼痛（被动拉伸、定位），不自主运动（夹板固定），挛缩预防（定位、矫形器、任务练习），主动功能（任务练习、矫形器），被动功能（矫形器、定位）。
在手臂和腿部的目标分类中发现了共性。在这些队列中，报告了针对腿部改善主动功能（行走和转移）的任务练习干预措施，但在手臂康复中并不常见。建议改进治疗规划可能会带来更大、更快的治疗目标实现以及更好的治疗效果。
