Goal-Setting Method and Goal Attainment Measures in Physical Therapy for Stroke Patients: a Systematic Review

Facilitators and barriers to patient-centred goal-setting in rehabilitation: A scoping review

Objective

Identify, map, and synthesize existing reviews, to extract and analyse the most prominent barriers and facilitators to applying patient-centred goal-setting practice in rehabilitation using the Capability, Opportunity Motivation Behaviour (COM-B) model.

Design

Scoping review.

Data source

A primary search was conducted in MEDLINE, CINAHL, EMBASE, PsychInfo, and Cochrane. Citation chaining was employed.

Review methods

All types of review (systematic, scoping, and narrative) studies published up to June 14, 2022 that included physical and neurological rehabilitation, patient-centeredness, and goal-setting were reviewed. Studies were scrutinized for relevance, quality was not assessed. The most prominent barriers and facilitators were synthesized using thematic content analysis and mapped onto the COM-B model.

Results

Twenty-six review studies covering a range of conditions and settings, acute to community were included. Barrier and facilitators were identified at patient, provider, and organizational level. Barrier themes include provider's existing beliefs about goal-setting, lack of skills, and integration into clinical routines. Patient barriers related to capacity and opportunity to participate. Organizational barriers include lack of clinical guidelines, patient preparation, insufficient provider time, and high productivity expectations. Facilitators included goal-setting guidelines, training and education of providers and patients, revised clinical routines, performance monitoring, adequate time, and resources.

Conclusion

Healthcare providers should be the primary target of intervention. A provider's motivation to change current practice is the most prominent barrier, followed closely by capacity and opportunity. Patients require information, training, and structured engagement opportunities. Organizations play a key role in creating the optimal environmental conditions to enable patient-centred goal-setting.

Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke

Objective

Develop and test a person-centred goal-setting package for discharge care planning in acute and rehabilitation stroke units.

Methods

A multidisciplinary, expert working group (n = 15), and consumer group (n = 4) was convened. A multistage iterative approach was used to develop and test the package. Stages included: (i) contextual understanding, (ii) package development, and (iii) clinician training and field-testing in acute and rehabilitation settings. Observational field notes were taken and clinicians' perspectives captured using semi-structured focus groups post-testing.

Results

The final package included a 34-item menu aligned with a manual containing: guideline summaries; common goals; goal metrics based on the SMART Goal Evaluation Method (SMART-GEM); evidence-based strategies; and worked examples. Twenty-three clinicians attended training. Clinician observations (n = 5) indicated that: the package could be incorporated into practice; a range of person-centred goals were set; and opportunities provided to raise additional issues. Clinician feedback (n = 8) suggested the package was useful and facilitated person-centred goal-setting. Enablers included potential for incorporation into existing processes and beliefs that it promoted person-centred care. Barriers included additional time.

Conclusion

The package demonstrated potential to facilitate comprehensive person-centred goal-setting for patients with stroke.

Innovation

We developed an innovative approach to support structured person-centred goal setting in clinical and research settings.

The correlation between occupational performance and well-being in stroke patients

[Purpose] This study was performed to evaluate the occupational performance of stroke patients and their environment by occupational self-assessment and to investigate the relationship between occupational performance and well-being. [Subjects and Methods] This study enrolled ninety-two stroke patients who were receiving occupational therapy at a general hospital, a rehabilitation hospital, or a community welfare center in the cities of Busan and Gimhae, Republic of Korea. Occupational performance and well-being were investigated with Occupational Self-Assessment Version 2.2 and the Personal Well-being Index-Adult. [Results] Analysis of the correlation between occupational performance as assessed by the "Myself" and "My Environment" sections of Occupational Self-Assessment Version 2.2 and well-being revealed moderate positive correlation for both sections. [Conclusion] The relationship between occupational performance and well-being was identified. Further studies are needed to reveal whether improvement of occupational performance could affect well-being in various dimensions.

Analysis of cortical activation during three types of therapeutic activity

[Purpose] The objective of this study was to investigate changes from resting of the evoked cortical activity when participants performed three levels of therapeutic activities. [Subjects and Methods] Twenty-five students participated in this study. Changes in the amplitude of 16 pairs of evoked potentials were compared for three different activities: adjunctive, enabling, and purposeful. Data were analyzed using descriptive statistics and one-way ANOVA. [Results] Significant differences were found among the selected three activities for the Alpha 1 waveform. The complexity hierarchy was confirmed by descriptive statistics, as well as analyses of the three brain regions: central position (motor) Beta 1; parietal lobes, Beta 2, and occipital lobes, Alpha 1. In each instance, purposeful activity was confirmed as the most complex activity, followed by enabling, and then adjunctive. [Conclusion] This study will provide rehabilitation professionals with valuable information regarding what type of activity they should choose for a correct level of therapeutic challenge when they work with patients to plan meaningful interventions.

Differences in understanding and subjective effects of home-visit rehabilitation between user families and rehabilitation providers

[Purpose] This study aimed to clarify differences in understanding and subjective effects of home-visit rehabilitation between user families and rehabilitation providers. [Subjects] The subjects were home-visit rehabilitation providers and user families. [Methods] Home-visit rehabilitation providers and user families completed a self-administered questionnaire regarding the content and subjective effects of home-visit rehabilitation. For statistical analysis, the McNemar’s test was used. [Results] Fifty pairs of responses met the inclusion criteria. The mean age of user families was 65.0 ± 11.2 years, and 58.0% (29/50) were spouses of users (user mean age, 77.7 ± 10.2 years; 48.0% (24/50) female). With regard to home-visit rehabilitation content, user families thought that paralysis improvement exercise, massage, and self-care activities were implemented to a greater degree than did rehabilitation providers. With regard to the subjective effects of home-visit rehabilitation, a higher proportion of user families noticed “maintenance/improvement” effects on symptoms and sequelae, as well as pain and suffering, compared with providers. [Conclusion] User families believed that rehabilitation would also improve users’ symptoms and pain. Care providers should explain the aims of home-visit rehabilitation to users and their families, both of which require a strong understanding of home-visit rehabilitation in order to achieve rehabilitation goals.

Differences between home-visit rehabilitation users and providers in their understanding of the content and subjective effects of rehabilitation practices

[Purpose] This study aimed to clarify differences between home-visit rehabilitation users and providers in their understanding of the content and subjective effects of this practice. [Subjects] The subjects of this study were home-visit rehabilitation users and providers. [Methods] Home-visit rehabilitation users and providers were given self-administered questionnaires regarding home-visit rehabilitation, such as the content and subjective effects. The McNemar’s test was used for statistical analysis. [Results] Responses of 34 pairs meeting the inclusion criteria were analyzed. Mean user age was 75.2 ± 9.2 years, and 58.8% (20/34) of respondents were female. In terms of home-visit rehabilitation content, users believed that the following 3 items had been “implemented” to a greater extent than that estimated by providers: paralysis improvement exercise, floor sitting and standing, and self-care activities. No significant differences in awareness were identified between users and providers regarding the maintenance/improvement effects of home-visit rehabilitation. [Conclusion] Users tend to consider that programs aimed at relieving symptoms and pain and improving mobility are being implemented to a greater extent than that considered by providers. Providers need to explain the aims of home-visit rehabilitation programs in a way that can be understood by users.

Development of a rehabilitation goal menu for inpatients with neurological disorders: application in a Saudi Arabian context

OBJECTIVE

To develop a rehabilitation goal menu based on understanding the specific goals that are important to neurological inpatients and that fall within commonly identified rehabilitation domains.

DESIGN

Qualitative methods (semi-structured interview, focus groups) to develop a goal menu followed by cross-sectional study to measure participants' goal rankings.

SETTING

Rehabilitation hospital in Saudi Arabia.

SUBJECTS

A total of 130 participants with neurological injury.

MAIN MEASURES

Participant rankings of rehabilitation goals and self-reported level of difficulty in areas such as mobility, self-care, accessibility, productivity, and leisure.

RESULTS

A 10-item goal menu was developed based on initial focus groups, semi-structured interviews, and literature review. The overall highest ranked rehabilitation goal was Functional Mobility/Locomotion, followed by Self-Care and Religious/Life Philosophy. Self-reported level of difficulty with mobility was strongly associated with the ranking of Functional Mobility/Locomotion as a rehabilitation goal. However, there was little correspondence between reported difficulty and priority ranking of self-care. Subsequent factor analysis of detailed goal items suggest that the goal menu could be reduced to seven items.

CONCLUSIONS

This study provided an understanding of which rehabilitation goals are important to Saudi clients with neurological disorders that could be used to facilitate their contribution to the goal-setting process.

Goal setting with caregivers of adults in the community: a mixed methods systematic review

PURPOSE

To examine how goal setting is used with caregivers of community residing adults and the effect of goal setting practices in improving the outcomes.

METHODS

A mixed methods systematic review was conducted. The methodological rigour of included studies was critiqued using Cochrane Collaboration's risk of bias assessment tool, Downs and Black checklist and a framework for evaluating qualitative research. Narrative synthesis was created through tabulation and categorisation, visual mapping of the goal setting process, thematic analysis on common goal setting features and critical reflection on the accuracy and robustness of the synthesis.

RESULTS

Seventeen studies were included: 10 randomised trials, 5 other quantitative studies and two descriptive studies which incorporated qualitative methods. The trials demonstrated a relatively low risk of bias in contrast to the other studies that had varied methodological rigour. No studies isolated the effect of the goal setting process on outcomes and therefore the effectiveness of goal setting could not be evaluated. However, through a narrative synthesis six prominent features of collaborative goal setting were identified.

CONCLUSIONS

Despite the fact that goal setting is an important component of client-centred care, and the prominence of client-centred care in healthcare discourse, the review uncovered a surprisingly limited number of studies. Goal setting is an elusive process that is of therapeutic value and warrants further investigation. Implications for Rehabilitation The current body of empirical evidence suggests that there are six prominent features of collaborative goal setting with caregivers. The goals that are most important to caregivers are often different to those that are important to clinicians; it is important that caregivers and clinicians agree on goals to maximise adherence to treatment and goal attainment. The quality of evidence for goal setting with caregivers is limited although some intervention trials illustrate the usefulness of collaborative goal setting in contributing to improved outcomes.