Clinical Practice Guidelines (CPGs) seek to optimize patient care based on the best available evidence, clinician expertise, and patients’ goals. Implementing CPG’s into clinical practice requires the use of appropriate outcome measures to optimize patient care, track change over time and examine intervention effectiveness. 

The CPG for the Use of Ankle Foot Orthoses (AFO) and Functional Electrical Stimulation (FES) Post Stroke provides evidenced-based recommendations at the participation, activity, and body function and structure levels, as defined by the International Classification of Function, Disability, and Health (ICF) Model. This framework ensures CPG recommendations are patient-centered and focused on the outcome of interest. While a variety of outcomes were extracted from the literature, outcomes more frequently used and with strong psychometric properties are highlighted in the CPG. For example, Action Statement 4 states that “Clinicians SHOULD provide an AFO or FES for individuals with decreased lower extremity motor control due to CHRONIC post-stroke hemiplegia who have goals to improve dynamic balance.” This recommendation is supported by a preponderance of Level I evidence that demonstrated statistically significant and often clinically meaningful change in dynamic balance with an AFO or FES. Dynamic balance can be objectively captured by standardized outcome measures including the Timed Up and Go, Berg Balance Scale, Activity-Specific Balance Confidence Scale, and Functional Gait Assessment. 

To promote effective implementation of the CPG, we created case-based examples that illustrate how outcome measures can guide patient-centered decision-making and improve the quality and consistency of care. Applying the Integrated Framework for Making Clinical Decisions Across the Lifespan and Health Conditions, we developed patient-specific hypotheses grounded in individual goals, expectations, and functional presentations. These hypotheses helped identify appropriate outcomes of interest, relevant action statement recommendations, and corresponding outcome measures to establish baseline status and evaluate intervention effectiveness. Monitoring of these outcomes allows clinicians to adjust treatment plans and engage patients in shared decision-making throughout the course of care. 

In developing the CPG, we encountered challenges when synthesizing the literature, particularly regarding inconsistent use of standardized outcome measures and misalignment between selected measures and the targeted outcomes. For example, if a patient aims to walk on uneven terrain or navigate stairs, but the chosen outcome measure assesses static standing balance, the data would fail to capture whether the intervention addressed the patient’s actual goals. These discrepancies highlight the importance of selecting outcome measures that directly reflect the functional outcomes patients seek to achieve.