Are Specific, Measurable, Action-Oriented, Realistic, and Time-Bound (SMART) Goals Associated With Improved Walking Outcomes for Stroke Survivors Undergoing Outpatient Stroke Rehabilitation? An Observational Cross-Sectional Retrospective Cohort Study

ABSTRACT Background Goal-setting is a core principle used in clinical practice to guide treatment. Setting goals improves adherence to rehabilitation treatments and may lead to better outcomes in people with neurological disorders. However, there is a lack of research into the prevalence of goals using a Specific, Measurable, Action-Oriented, Realistic, and Time-Bound (SMART) framework. Additionally, it is currently unclear if the SMART framework improves ambulatory outcomes in outpatient stroke rehabilitation. Methods This observational, cross-sectional, retrospective cohort study reviewed charts of all patients admitted to outpatient stroke rehabilitation at three hospitals over a 1-year period. Patients were included in the analysis if they had documented ambulatory goals. Goals were classified as either SMART or non-SMART. Analysis of covariance was used to compare Functional Ambulation Category scores at discharge between the SMART and non-SMART groups, controlling for admission scores, length of stay, and time post-stroke. Results 300 patients were included in the analysis. Of these, 61 (20.3%) had at least one SMART ambulatory goal. Analysis of covariance revealed a statistically significantly greater Functional Ambulation Category scores at discharge for the SMART goal group compared to the non-SMART group (mean Functional Ambulation Category scores at discharge [95% confidence interval], SMART group: 4.2 [4.0, 4.5], non-SMART group: 3.8 [3.6, 4.1]; F 1,60 = 4.40, p = 0.043). Conclusion The use of SMART goals in outpatient stroke rehabilitation is associated with better ambulatory outcomes compared to non-SMART goals. These findings suggest that incorporating the SMART framework in clinical practice can enhance the effectiveness of rehabilitation interventions for stroke patients. Further studies are recommended to explore the long-term effects and broader applications of SMART goal-setting.