What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis

Abstract

Objective:To identify the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries.Data sources:AMED, Proquest, CINAHL and MEDLINE.Review methods:Two reviewers independently screened, extracted data and assessed study quality using the Mixed Methods Appraisal Tool and undertook thematic content analysis for papers examining the barriers and facilitators to goal-setting during stroke/neurological rehabilitation (any design). Last searches were completed in May 2016.Results:Nine qualitative papers were selected, involving 202 participants in total: 88 patients, 89 health care professionals and 25 relatives of participating patients. Main barriers were: Differences in staff and patients perspectives of goal-setting; patient-related barriers; staff-related barriers, and organisational level barriers. Main facilitators were: individually tailored goal-setting processes, strategies to promote communication and understanding, and strategies to avoid disappointment and unrealistic goals. In addition, patients’ and staff’s knowledge, experience, skill, and engagement with goal-setting could be either a barrier (if these aspects were absent) or a facilitator (if they were present).Conclusion:The main barriers and facilitators to goal-setting during stroke rehabilitation have been identified. They suggest that current methods of goal-setting during inpatient/early stage stroke or neurological rehabilitation are not fit for purpose.

Nursing practice in stroke rehabilitation: Perspectives from multi‐disciplinary healthcare professionals

“…Inadequate staffing was identified as the leading barrier in providing stroke-rehabilitation nursing, which was similar to the results reported in previous studies (Baatiema et al, 2017;Gache et al, 2014;Loft et al, 2017;Seneviratne et al, 2009). Contrary to the findings of previous studies (Baatiema et al, 2017;Plant et al, 2016), nurses possessing knowledge and skills related to rehabilitation nursing stated that they could not practice appropriate rehabilitation nursing because of limited nursing time. Moreover, lack of policy support was identified as a significant barrier from the participants' perspective, which was not addressed in previous studies, and could be related to different cultural backgrounds.…”

“…Other rehabilitation professionals and patients might also not appreciate nurses' contribution to stroke rehabilitation (Digby, Bolster, Perta, & Bucknall, 2018;Kirkevold, 2010;Loft et al, 2017;Nolan & Nolan, 2014). Furthermore, some qualitative studies have explored barriers hindering nurses' engagement in stroke-rehabilitation care, including nurses' attitudes and beliefs (Loft et al, 2017); lack of time, inadequate nursing staff, or work overload (Baatiema et al, 2017;Gache et al, 2014;Loft et al, 2017;Seneviratne, Mather, & Then, 2009); lack of rehabilitation knowledge and skills (Baatiema et al, 2017;Plant, Tyson, Kirk, & Parsons, 2016); and limited understanding of rehabilitation nursing care and lack of cooperation from other healthcare professionals (Digby et al, 2018), the overcoming of which might help develop effective strategies for integrating nursing practice with stroke-rehabilitation care.…”

Barriers and enablers to aligning rehabilitation goals to patient life roles following acquired brain injury

“…Furthermore, clinicians also expressed perceptions of organisational expectations to focus on self‐care skills in practice, suggesting that such expectations may lead clinicians to pursue goals relating to self‐care despite lack of clear alignment to roles. This is consistent with previous studies that suggest that perceived organisational pressures around facilitating discharge can lead to the establishment of predetermined goals by clinicians which may not always be person‐centred and role‐oriented (Hunt, Le Dorze, Trentham, Polatajko & Dawson, ; Plant et al ., ).…”

“…Similarly, previous studies have highlighted the link between evolving self‐awareness and ability to effectively set rehabilitation goals (Doig et al ., ; Turner et al ., ), with participation in rehabilitation over time thought to be an enabler in building knowledge and awareness around realistic and achievable goals. These results are consistent with findings of two systematic reviews (Plant et al ., ; Sugavanam, Mead, Bulley, Donaghy & van Wijck, ) that provide recommendations that goal setting education for patients be completed.…”

Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis

“…If the clinician is not able to involve individuals with aphasia or dysphasia in the “goal-setting process”[37], it is important to resort to other means such as involving their families, or using card sorting [23,24]. The disconnect between the expectations of clinicians and stroke survivors and their caregivers can be attributed to the patient complexities including, patient’s personal characteristics, availability of support, social determinants, and health system factors geared towards discharging patients sooner from the hospital [38].…”