Goal-setting in stroke rehabilitation v1.0
Research type
Research Study
Full title
Understanding the patients' experience of goal-setting during in-patient stroke rehabilitation
IRAS ID
272499
Contact name
Audrey Bowen
Contact email
Sponsor organisation
University of Manchester
Duration of Study in the UK
1 years, 4 months, 29 days
Research summary
Summary of Research
Goal-setting during in-patient stroke rehabilitation is a way of helping patients and their therapy team agree targets (such as learning to walk again) to work towards during their rehabilitation after their stroke. Goal-setting is an important aspect of rehabilitation and is recommended in the National Clinical Guidelines. Although widely used, evidence shows there are many barriers to carrying out goal-setting, particularly in the hospital setting. Some research has investigated the opinions of stroke survivors, however it is still unclear as to how much involvement the stroke survivor wants to have in the goal-setting process this soon after their stroke. Some people may struggle to engage in the process so early on from a life-changing event and find it difficult to know what they are realistically able to achieve. Clinicians also have difficulty in identifying suitable goals and are unsure how and when to involve the patient. This study therefore aims to explore the experience of the stroke survivor on the process of goal setting in the hospital setting. It will be conducted with adult stroke survivors who: are receiving therapy from a hospital in-patient stroke team, have had goals set with physiotherapists and/or occupational therapists and are able to consent for an interview to take place. Participants will be asked to take part in two interviews that will be recorded (referred to as longitudinal interviews throughout); the first during their hospital stay and the second after discharge. We might not have enough time to conduct the second interviews and some people may decline to take part again so we will also conduct a single interview (referred to as cross-sectional interview throughout) with a different set of people, those who were discharged in the six months prior to the study starting. Whilst there are no direct benefits to the participants, it will help to inform future goal setting practice. This study has been funded by the Stroke Association. The research will be carried out over a six month time period at stroke units across the North West of England. Interviews will be held in stroke units and community settings such as in a person’s home. If preferred the interviews can be by telephone.
Summary of Results
Understanding the patients' experience of goal-setting during in-patient stroke rehabilitation
This research was funded by the Stroke Association and was sponsored by the University of Manchester as part of a PhD qualification.
Goal-setting is seen to be a fundamental part of rehabilitation that helps recovery after a stroke, guiding both the clinical team and stroke survivor through the rehabilitation process. There are many ways to carry out goal-setting, however it remains unclear as to the best ways to involve the stroke survivor in the process. The aims of this current study were to explore stroke patients’ experience specifically of the inpatient goal-setting process, their understanding of goal-setting, the terms used and their views on how to achieve good goal-setting, all from the perspective of the patient.
All participants were stroke survivors who had either recently had a stroke or had a stroke within the last six months. We carried out interviews with stroke survivors whilst they were still an inpatient in hospital and then again when they went home. We also interviewed stroke survivors who had been discharged home within the last six months. Twenty four stroke survivors were interviewed in total. Thirteen people we talked to had one interview, 11 people had two interviews – one when in hospital and another when they got home. All interviews took place between September 2020 and December 2021.
We found there were four areas that most people talked about: Identifying goals, therapist as an expert, encouragement, hospital and home goals.
Identifying goals
For a lot of people the word goal means something to aim for, achieve or get back to normal. For most people their main goals in hospital were to walk again, regain independence and go home.Therapist as an expert
Sometimes it can be difficult for people to decide what they needed to achieve whilst in hospital. For some, early after their stroke was too soon to be thinking about goals. Some people were happy for the therapists to decide what their goals were as they knew best as to what was to be done.Encouragement
It was important to many people that they were able to see that they had improved. Many felt that the praise and encouragement they got from the therapist showed they were improving.Hospital and home goals
People felt that in hospital there was a focus on the goals needed to get home. Once home, people felt that goals changed and were around the things they previously enjoyed doing.A second study looking at the experience of therapists who provide rehabilitation for stroke survivors after their stroke has also been conducted. It is hoped that by combining the results from both studies, the results will be used to help inform further research into goal-setting and will help develop further the understanding of how goal-setting happens in hospital.
Thank you to all of the study participants who took part in this research.
REC name
East of England - Cambridgeshire and Hertfordshire Research Ethics Committee
REC reference
20/EE/0186
Date of REC Opinion
2 Sep 2020
REC opinion
Further Information Favourable Opinion