Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation

Abstract

BackgroundGoal setting is considered ‘best practice’ in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke.MethodsG-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation.ResultsG-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient’s well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process.ConclusionsG-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings.

Musculoskeletal physiotherapists’ use of psychological interventions: a systematic review of therapists’ perceptions and practice

“…Furthermore the use of psychological interventions appears to be growing in certain disciplines of physiotherapy; namely chronic pain (11), anterior cruciate ligament rehabilitation (10) neurology (12,13) and sport (2). Techniques such as cognitive behavioural therapy (CBT), neuro-linguistic programming (NLP) are also other psychological techniques widely being used by physiotherapists within these areas (14,15).…”

Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey

“…These findings support our view that whilst G-AP and ''usual'' practice will (to differing degrees) share commonalities, there are critical differences. These differences have the potential to improve patient outcomes by optimising goal attainment and/or facilitating goal adjustments or disengagement if progress is not being made [12,32,33].…”

“…However, they do not guide health professionals through all stages of the goal-setting process [31]. The G-AP framework includes, (i) a patient-centred planning stage (which details goal-related activities that will optimise patients' behaviour as they pursue their personal goals) and (ii) an appraisal, feedback and decision-making stage (which informs practice following goal-related successes, setbacks and failures) [10][11][12]. These activities are not explicitly stated in other approaches to goal-setting practice.…”

“…It is evidence and theory based [10] and has four key stages: (i) goal negotiation and setting; (ii) planning and measuring confidence; (iii) action; and (iv) appraisal, feedback and decision making [11,12]. G-AP shows promise as an acceptable and feasible framework for use in community-based stroke rehabilitation [12]. The next stage is to evaluate the effectiveness of G-AP when compared to ''usual'' goal setting practice.…”

Los recursos humanos en las nuevas empresas internacionales. El papel del engagement

“…El diseño del trabajo se puede implementar con la práctica del establecimiento del trabajo por objetivos (Umstot, Mitchell y Bell, 1978), los cuales pueden ser revisados formal o informalmente (Scobbie, et al, 2013).…”