What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis.
Sarah E Plant, Sarah F Tyson, Susan Kirk and 1 others
PMID 27496701WHAT IT FOUND
Patients tended to want broad, long-term goals; staff tended to set short, impairment-focused goals.
Use early therapist-led goal-setting when patients prefer it, and shift to patient-led goals after discharge.
Key findings
01Patients tended to set broad, long-term goals about hope and independence, while staff tended to set short-term, impairment-focused goals.
02Some patients, especially early after stroke, preferred a therapist-led approach, while others became more able to identify personally significant goals after discharge.
03Tailoring the process to patients, early and frequent communication, support materials and aphasia-friendly resources were reported facilitators.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This review synthesises qualitative experiences and themes; it does not show that goal-setting improves recovery, goal achievement or patient satisfaction. Only English, peer-reviewed studies were searched, and unpublished work was not sought, so relevant studies could have been missed. Patients with communication or cognitive limitations were often excluded from the included goal-setting studies, so the findings may not cover people who need adapted processes most. The included studies were mostly in in-patient stroke or rehabilitation units, with some post-discharge interviews, so they may not reflect community or later rehabilitation settings. The authors are stroke physiotherapists and academics working on improving team practice, which may influence analysis.
The easy way to misread this
Do not read this as evidence that patient-centred goal setting improves outcomes. The review reports themes from qualitative studies, and it found that some patients early after stroke prefer staff to lead goal-setting.