Among 150 young stroke patients surveyed through NUHS’ Patient Reported Outcomes Measures (PROMs):

• Four in 10 reported anxiety symptoms
• One in four experienced fatigue
• One in six reported sleep disturbance

Many had already returned home and regained much of their physical function. Yet they continued to experience symptoms that affected their ability to work, sleep, socialise and go about their daily lives.

Looking beyond what clinicians can see

For decades, stroke recovery has largely been assessed through clinical and functional indicators, such as whether a patient can walk, speak and perform daily activities independently. These measures remain important, but they tell only part of the story.

Dr Benjamin Tan, Consultant, Division of Neurology, National University Hospital (NUH), said traditional stroke assessments are effective at measuring physical recovery, but often miss the non-motor consequences that patients continue to live with long after discharge.

“A patient may appear to have physically recovered. But that does not necessarily mean recovery is complete,” said Dr Tan.

Many challenges that affect quality of life, including fatigue, anxiety symptoms, depressive symptoms and sleep disturbance, may not be readily visible during a standard assessment.

Measuring what matters to patients

NUHS introduced PROMs into routine care to better understand recovery from the patient's perspective, including its impact on symptoms, wellbeing and everyday life.

Mr Jegatheesvaran Pradeeba, Senior Manager, Academic Informatics Office, National University Health System (NUHS), who supports the implementation of PROMs under the Patient Reported Outcomes for Value and Experience (PROVE) programme, said healthcare has traditionally measured outcomes that matter to clinicians, such as complications, readmissions and mortality.

PROMs incorporate the patient’s perspective by capturing whether they can sleep through the night, return to work, take part in family life, and regain confidence and independence.

The symptoms that stay hidden

One patient under Dr Tan’s care had regained much of her physical function and returned to work. Yet over time, challenges that were not immediately apparent began to affect her daily life.

During a routine clinic review, her PROMs responses highlighted concerns about sleep and emotional wellbeing that might otherwise have gone unrecognised. This sparked a broader conversation about how stroke was affecting her life and helped guide subsequent care.

The consultation became more than a review of neurological recovery. It evolved into a conversation about what recovery actually meant for her.

When PROMs flag concerns, clinicians can explore them together with patients and decide what support may be appropriate—whether it may be medication, counselling or psychological support, sleep assessment, or closer follow-up.

Turning patient voices into better care

The value of PROMs extends beyond individual consultations.

The young adult stroke survivor programme currently includes about 150 patients, creating a growing dataset on non-motor outcomes after stroke and offering a clearer picture of symptoms that may be missed by conventional measures of recovery.

Mr Pradeeba said the real value of PROMs emerges when patient-reported outcomes are combined with traditional clinical indicators.

This reflects a core principle of value-based healthcare: outcomes become meaningful when they help teams understand variation, redesign care and improve future outcomes.

From PROMs to PROVE

The young adult stroke survivor programme forms part of NUHS’ broader PROVE initiative, which systematically collects, integrates and analyses patient-reported outcomes and experiences across multiple conditions and care settings.

NUHS has worked closely with clinicians to co-design workflows so that PROMs are practical, meaningful and sustainable in real-world clinical settings.

The focus is not simply to introduce questionnaires, but to embed patient-reported outcomes into everyday care and use the data to support clinical decisions and system-wide improvement.

Redefining a good outcome

Traditionally, a good outcome after stroke might mean surviving, avoiding complications and regaining physical function. Those goals remain important, but PROMs show that recovery also includes emotional wellbeing, confidence, social participation, sleep quality, fatigue, the ability to work and quality of life.

These outcomes shape how patients experience recovery every day, yet they are often absent from traditional assessments. PROMs help make them visible — and weave them into routine care.

PROMs remind clinicians that recovery is not complete simply because it can be recorded in a scan, score or dashboard.

By listening directly to patients, clinicians can see what conventional measures may miss — and respond to the realities that shape life after stroke.

Because the true measure of recovery is not only what clinicians can see. It is whether patients can return to the lives they want to lead.

In consultation with Dr Benjamin Tan, Consultant, Division of Neurology, NUH, and Mr Jegatheesvaran Pradeeba, Senior Manager, Academic Informatics Office, NUHS.