Rehabilitation team members‘ view on how goal-setting is practised in patients after stroke
DOI:
https://doi.org/10.6016/ZdravVestn.2694Keywords:
stroke, rehabilitation, goal setting, rehabilitation team membersAbstract
Background: Goal-setting is a key element in the rehabilitation process of stroke patients. Patient centeredness has not only become an important underlying principle for the delivery of health and rehabilitation services, it has also become an important aspect of the goal-setting process. Current research in the area of stroke rehabilitation suggests that there is a lack of consensus concerning best practice for goal-setting. The aim of the study was to determine how rehabilitation team members set rehabilitation goals in patients after stroke, which assessment tools do they use and what obstacles are present during the goal-setting process.
Methods: Qualitative semi-structured interviews were conducted with 35 stroke unit rehabilitation team members at the University Rehabilitation Institute. The interview included questions about clinical experience of goal-setting process generally in rehabilitation, the use of assessment tools and problems that arise in setting goals.
Results: Most of the team members already used goal-setting as a measure of the effectiveness of rehabilitation treatment and perceived goal-setting as demanding. Most common mentioned barriers to goal-setting were lack of time, and patient characteristics (disease, personality and expectations). Specific improvements were suggested regarding education.
Conclusion: This study highlights a number of issues relevant to rehabilitation team members during the goal-setting process in stroke rehabilitation. Rehabilitation process should be pati-ent-centred and goal-directed. In the future, it is important to develop clear guidelines about goal-setting in stroke rehabilitation, as well as additional training for healthcare professionals.
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References
1. Young J, Forster A. Review of stroke rehabilitation. BMJ. 2007;334(7584):86-90.
DOI: 10.1136/bmj.39059.456794.68
PMID: 17218714
2. Wade DT. Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil. 2009;23(4):291-5.
DOI: 10.1177/0269215509103551
PMID: 19293289
3. Gage M. The patient-driven interdisciplinary care plan. J Nurs Adm. 1994;24(4):26-35.
DOI: 10.1097/00005110-199404000-00010
PMID: 8151422
4. Young CA, Manmathan GP, Ward JC. Perceptions of goal setting in a neurological rehabilitation unit: a qualitative study of patients, carers and staff. J Rehabil Med. 2008;40(3):190-4.
DOI: 10.2340/16501977-0147
PMID: 18292920
5. Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil. 2011;25(6):501-14.
DOI: 10.1177/0269215510394467
PMID: 21441308
6. Sugavanam T, Mead G, Bulley C, Donaghy M, van Wijck F. The effects and experiences of goal setting in stroke rehabilitation - a systematic review. Disabil Rehabil. 2013;35(3):177-90.
DOI: 10.3109/09638288.2012.690501
PMID: 22671934
7. Parsons JG, Plant SE, Slark J, Tyson SF. How active are patients in setting goals during rehabilitation after stroke? A qualitative study of clinician perceptions. Disabil Rehabil. 2018;40(3):309-16.
DOI: 10.1080/09638288.2016.1253115
PMID: 27866416
8. Levack WM, Weatherall M, Hay-Smith JC, Dean SG, McPherson K, Siegert RJ. Goal setting and strategies to enhance goal pursuit in adult rehabilitation: summary of a Cochrane systematic review and meta-analysis. Eur J Phys Rehabil Med. 2016;52(3):400-16.
PMID: 26771917
9. Lloyd A, Roberts AR, Freeman JA. ‘Finding a balance’ in involving patients in goal setting early after stroke: a physiotherapy perspective. Physiother Res Int. 2014;19(3):147-57.
DOI: 10.1002/pri.1575
PMID: 24302610
10. Holliday RC, Cano S, Freeman JA, Playford ED. Should patients participate in clinical decision making? An optimised balance block design controlled study of goal setting in a rehabilitation unit. J Neurol Neurosurg Psychiatry. 2007;78(6):576-80.
DOI: 10.1136/jnnp.2006.102509
PMID: 17178823
11. McGrath JR, Davis AM. Rehabilitation: where we going and how do we get there? Clin Rehabil. 1992;6(3):225-35.
DOI: 10.1177/026921559200600307
12. Scobbie L, Wyke S, Dixon D. Identifying and applying psychological theory to setting and achieving rehabilitation goals. Clin Rehabil. 2009;23(4):321-33.
DOI: 10.1177/0269215509102981
PMID: 19293291
13. Levack WM, Taylor K, Siegert RJ, Dean SG, McPherson KM, Weatherall M. Is goal planning in rehabilitation effective? A systematic review. Clin Rehabil. 2006;20(9):739-55.
DOI: 10.1177/0269215506070791
PMID: 17005499
14. Thomson C, Black L. An exploratory study of the differences between unidisciplinary and multidisciplinary goal setting in acute therapy services. Br J Occup Ther. 2008;71(10):422-6.
DOI: 10.1177/030802260807101004
15. Hartigan I. Goal setting in stroke rehabilitation: part 2. How do health professionals set goals and what is the nurse's role? Br J Neurosci Nurs. 2012;8:123-8.
DOI: 10.12968/bjnn.2012.8.3.123
16. Playford ED, Dawson L, Limbert V, Smith M, Ward CD, Wells R. Goal-setting in rehabilitation: report of a workshop to explore professionals’ perceptions of goal-setting. Clin Rehabil. 2000;14(5):491-6.
DOI: 10.1191/0269215500cr343oa
PMID: 11043874
17. Levack WM, Dean SG, McPherson KM, Siegert RJ. How clinicians talk about the application of goal planning to rehabilitation for people with brain injury-variable interpretations of value and purpose. Brain Inj. 2006;20(13-14):1439-49.
DOI: 10.1080/02699050601118422
PMID: 17378236
18. Levack WM, Dean SG, Siegert RJ, McPherson KM. Navigating patient-centered goal setting in inpatient stroke rehabilitation: how clinicians control the process to meet perceived professional responsibilities. Patient Educ Couns. 2011;85(2):206-13.
DOI: 10.1016/j.pec.2011.01.011
PMID: 21306859
19. Van De Weyer RC, Ballinger C, Playford ED. Goal setting in neurological rehabilitation: staff perspectives. Disabil Rehabil. 2010;32(17):1419-27.
DOI: 10.3109/09638280903574345
PMID: 20624106
20. Playford ED, Siegert R, Levack W, Freeman J. Areas of consensus and controversy about goal setting in rehabilitation: a conference report. Clin Rehabil. 2009;23(4):334-44.
DOI: 10.1177/0269215509103506
PMID: 19449469
21. Nair KP, Wade DT. Satisfaction of members of interdisciplinary rehabilitation teams with goal planning meetings. Arch Phys Med Rehabil. 2003;84(11):1710-3.
DOI: 10.1053/S0003-9993(03)00313-7
PMID: 14639574
22. Al-Haidary H, Qannam H, Lam T. Development of a rehabilitation goal menu for inpatients with neurological disorders: application in a Saudi Arabian context. Clin Rehabil. 2015;29(10):1002-12.
DOI: 10.1177/0269215514561877
PMID: 25540171
23. Plant S, Tyson SF. A multicentre study of how goal-setting is practised during inpatient stroke rehabilitation. Clin Rehabil. 2018;32(2):263-72.
DOI: 10.1177/0269215517719485
PMID: 28714342
24. Loft MI, Esbensen BA, Kirk K, Pedersen L, Martinsen B, Iversen H, et al. Nursing staffs self-perceived outcome from a rehabilitation 24/7 educational programme - a mixed-methods study in stroke care. BMC Nurs. 2018;17(1):17.
DOI: 10.1186/s12912-018-0285-z
PMID: 29719491
25. Bovend’Eerdt TJ, Botell RE, Wade DT. Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clin Rehabil. 2009;23(4):352-61.
DOI: 10.1177/0269215508101741
PMID: 19237435
26. Rice DB, McIntyre A, Mirkowski M, Janzen S, Viana R, Britt E, et al. Patient-Centered Goal Setting in a Hospital-Based Outpatient Stroke Rehabilitation Center. PM R. 2017;9(9):856-65.
DOI: 10.1016/j.pmrj.2016.12.004
PMID: 28082180
27. Scobbie L, Duncan EA, Brady MC, Wyke S. Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey. Disabil Rehabil. 2015;37(14):1291-8.
DOI: 10.3109/09638288.2014.961652
PMID: 25243765
28. Plant SE, Tyson SF, Kirk S, Parsons J. What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis. Clin Rehabil. 2016;30(9):921-30.
DOI: 10.1177/0269215516655856
PMID: 27496701
29. McClain C. Collaborative rehabilitation goal setting. Top Stroke Rehabil. 2005;12(4):56-60.
DOI: 10.1310/ELB1-EGKF-QUQC-VFE9
PMID: 16698737
30. Monaghan J, Channell K, McDowell D, Sharma AK. Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation. Clin Rehabil. 2005;19(2):194-9.
DOI: 10.1191/0269215505cr837oa
PMID: 15759535
31. Neistadt ME. Methods of assessing clients’ priorities: a survey of adult physical dysfunction settings. Am J Occup Ther. 1995;49(5):428-36.
DOI: 10.5014/ajot.49.5.428
PMID: 7598158
32. Holliday RC, Antoun M, Playford ED. A survey of goal-setting methods used in rehabilitation. Neurorehabil Neural Repair. 2005;19(3):227-31.
DOI: 10.1177/1545968305279206
PMID: 16093413
33. Leach E, Cornwell P, Fleming J, Haines T. Patient centered goal-setting in a subacute rehabilitation setting. Disabil Rehabil. 2010;32(2):159-72.
DOI: 10.3109/09638280903036605
PMID: 19562579
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