Escala de obtenção de metas como medida de desfecho na neurorreabilitação após o AVC: revisão sistemática metodológica

Abstract

Introduction: Stroke is a leading cause of mortality and global disability, a condition that significantly affects patients' functionality, impacting daily activities and quality of life. Rehabilitation plays a crucial role in functional recovery, with a focus on clear and personalized goals. The Goal Attainment Scaling (GAS) emerges as a promising tool to measure individual progress and guide more effective therapeutic interventions. However, its application faces challenges, such as the lack of standardization and the limited involvement of patients in goal setting. Therefore, a systematic review on the use of GAS in post-stroke rehabilitation is essential to consolidate evidence, identify gaps in the literature and improve clinical practices, aiming at the personalization and effectiveness of treatment. General objective: To perform a literature review on the methodological characteristics of the Goal Attainment Scaling in the neurorehabilitation of patients with stroke, addressing its specificities, effectiveness and the results obtained in this context. Materials and Methods: This study is a systematic methodological review. The search was performed in the PubMed, MEDLINE, SciELO, LILACS, Web of Science, CINAHL, Embase, Cochrane Library, Scopus and PEDro databases, using the terms and keywords, combined with Boolean operators, for “Stroke” and “Goal Attainment Scale”. The search was conducted in June 2024. Studies with adults at any stage of stroke that used GAS as the primary outcome in neurorehabilitation were included. Results: The sample was represented by 1,153 participants in the selected studies. The studies analyzed the different stages of stroke, the mean age ranged between 51.8 and 62.3 years, with a higher prevalence among men, who totaled 686 cases. GAS was widely used to measure functional gains, allowing the assessment of clinical progression or regression of patients, as well as the establishment of specific goals for each stage of stroke. Variations in the application of the scale were identified, with some studies using a five-point version (-2 to +2) and others using the six-point version, which includes the category "-3" for significant functional restrictions as well as the baseline that varied from (0 to -1) in some of the studies. Conclusion: The results of this review demonstrate that the GAS can be a reliable and useful tool in stroke rehabilitation, but there is a need for its standardization. This review will contribute to more consistent guidelines, facilitating its practical use and the comparison of new studies.