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Purpose: To understand therapeutic priorities, a secondary data analysis on a retrospective cohort was conducted to classify rehabilitation goals according to the International Classification of Functioning, Disability, and Health (ICF). Materials and Methods: Therapeutic goals from an initial outpatient physical or occupational therapy evaluation for patients post-stroke or with Parkinson disease, were classified into Level 1 of the ICF. Goals in the Activity and Participation component were further sub-classified as activity capacity or activity performance (self-report or direct) in daily life. Results: 776 goals across 104 participants were classified into Level 1 of the ICF. The majority, 73% (563/776) were classified as Activity and Participation, 20% (155/776) as Body Function and 2% (17/776) as Environmental Factors. Fifty-two percent (400/776) of all goals were classified as activity capacity and 21% (163/776) as activity performance in daily life, with 21% (160/776) of goals measuring self-report activity performance in daily life and less than 1% (3/776) of goals measuring direct activity performance in daily life. Conclusions: While the majority of therapeutic goals were classified into the Activity and Participation component, less than 1% of goals measured direct activity performance in daily life. If people seek outpatient rehabilitation to improve functioning in their real-world environment, therapeutic goal setting should reflect this. PREVIOUS PRESENTATION WORK: Portions of this content were presented at the 2023 Academy of Neurologic Physical Therapy Annual Conference and will be presented at the 2023 TIRR & UT Health International Stroke Rehab & Recovery Conference. IMPLICATIONS FOR REHABILITATION: The majority of therapeutic goals for an episode of outpatient neurorehabilitation were classified into the Activity and Participation component of the International Classification of Functioning, Disability, and Health. However, less than 1% of therapeutic goals measured direct activity performance in daily life. If people with neurological diagnoses seek out outpatient rehabilitation to improve functioning in their real-world environment, than therapeutic goal setting should reflect this. [ABSTRACT FROM AUTHOR] more...

Background and Purpose: We addressed questions about the potential discrepancy between improvements in activity capacity and improvements in activity performance in daily life. We asked whether this discrepancy is: Common in routine, outpatient care, or an artifact of intervention studies? Unique to upper limb (UL) rehabilitation, or is it seen in walking rehabilitation too? Only seen in persons with stroke, or a broader neurorehabilitation problem? Methods: A longitudinal, observational cohort of 156 participants with stroke or Parkinson disease (PD) receiving outpatient rehabilitation at 5 clinics was assessed around admission and monthly during their episode of care. Individual, longitudinal capacity (Action Research Arm Test or walking speed) and performance (wearable sensor measurements of use ratio or steps/day) data were modeled to extract predicted change scores. Simulation methods were used to determine whether an individual's change was greater than 1 standard error. Participants were classified into categories based on whether or not they improved in capacity (C+ or C−) and/or performance (P+ or P−). Results: A majority (59%) were classified as C+P−. Smaller portions of the sample were classified as C+P+ (20%) and C−P− (21%), with 1 participant (<1%) classified as C−P+. The proportions in the C+P− category were significantly larger in the stroke (χ2 = 48.7, P < 0.0001) and PD (χ2 = 24.3, P < 0.0001) walking subgroups than in the stroke UL subgroup. Discussion and Conclusions: The discrepancy between improvements in capacity and performance is a problem in routine, outpatient neurorehabilitation. If performance information were available, patients and clinicians could act to address it. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A396). [ABSTRACT FROM AUTHOR] more...