A multicentre study of how goal-setting is practised during inpatient stroke rehabilitation

Abstract

Objective: To describe goal-setting during in-patient stroke rehabilitation.Design: There were two stages: An electronic questionnaire for multi-disciplinary teams and an analysis of goal-setting documentation for rehabilitation patients. Setting: Five in-patient stroke unitsParticipants: Staff involved in goal-setting and patients undergoing stroke rehabilitation in Results: 13 therapists and 49 patients were recruited. 351 documented goals were examined. All units used therapist-led goal-setting (60% of goals were set by therapists).72% of goals were patient focussed but patients and families had little involvement. Goals focussed on basic mobility and activities of daily living (~50% and ~25% of goals respectively). Only 41% of documented goals met the SMART criteria. Review of progress was limited. 48% of goals were never reviewed and 24% of the remainder were merely marked as ''ongoing' without a date or plan for completion. New goals and actions were How is goal-setting practiced during stroke rehabilitation? 2 often documented without any connection to previous goals. Integration between goals and treatment/action plans was mixed. In two units, goals were unconnected to a treatment or action plan, but for the remainder it was 90-100%. However that connection was generally vague and amounted to suggestions of the type of treatment modality that staff might employ. Conclusions:Goal-setting during in-patient stroke rehabilitation is therapist-led but discussed with the multi-disciplinary team. Therapists mainly identified patient-focussed mobility and activities of daily living goals. Monitoring progress and revising goals were often uncompleted. Links between goals and treatment, action plans and progress were patchy.How is goal-setting practiced during stroke rehabilitation? 3

A qualitative study of patient-centered goal-setting in geriatric rehabilitation: patient and professional perspectives

“…5 To improve patient-centered goal-setting within geriatric rehabilitation, knowing what rehabilitation goals comprise from a patient perspective and how goals may change over time is important. Although some studies have investigated goal-setting together with the patient, they were mainly conducted within brain 6–8 or stroke rehabilitation 9–14 and provide insight into the goal-setting process rather than patient goals. One of the few studies that looked into geriatric rehabilitation goals from a patient perspective considered short-term goals within 24 hours after admission and found that patients’ most common goals were “going home” and “regaining independence in self-care.” Whether and how these goals change once they are attained and patients are discharged, however, remains unknown.…”

The Development of a Return to Work Intervention Programme for Stroke Survivor (SReTWIP): A Delphi Survey

“…Even though goal setting during stroke rehabilitation has been generally referred to as a single activity that is isolated from other rehabilitation processes in most literature [9][10][11], the experts felt it should be an integral part of the stroke survivors' assessment and treatment management plans. This position is similar to the report of Plant and Tyson [12] With regards to the implementation strategies, the multi-disciplinary team-based approach (MDT) was excluded, as experts felt that the interdisciplinary approach (IDT) was more suited for delivering the RTW intervention. Although MDT has been associated with improvements in the quality of stroke care by policy makers and clinical guideline developers in the literature [16][17][18][19], considering the context in which the RTW would take place and the stage during the care continuum when RTW intervention is to be implemented, the experts felt that the conceivable value of integrated team action may not be achieved using MDT.…”

The development of a return to work intervention programme for stroke survivor (SReTWIP): a Delphi survey

“…• When client is independent in performing leisure activities • When client is fully reintegrated in the community (such as participation in social groups) setting during stroke rehabilitation has been generally referred to as a single activity that is isolated from other rehabilitation processes [19,23,24]. Plant and Tyson [25], on the contrary asserted that goal setting process as well as patient's assessment during stroke rehabilitation are clearly interlinked. The above authors suggested the integration of the two processes in long term post stroke rehabilitation.…”