Goal Setting In Stroke Rehabilitation

It is evident that goal setting and patient-centred practice are concepts that have increasingly dominated discourse in stroke rehabilitation (Levack et al., 2011). Goal setting has fundamentally been considered a key component in current rehabilitation and is described as ‘the essence’ of effective stroke rehabilitation (Barnes and Ward, 2000, p. 8). However despite this, there is a demand for critical inquiry into the process of goal setting and the determination of outcome relative to goals in stroke rehabilitation. With reference to the evidence base this assignment will seek to critically evaluate the process of goal setting and the determination of outcomes relative to goals in stroke rehabilitation. A

Goal setting is considered ‘best practice’ in rehabilitation (McPhearson et al., 2009, p. 297) and patient-centred treatment are concepts described as essential features of any successful rehabilitation programme (Cott, 2004). Holliday et al. (2007) examined the patients perspective of goal setting in a neurological rehabilitation setting and it was found that healthcare professionals needed to explore patients’ understandings of their disease and their experiences and expectations of goal setting to ensure goal setting is a meaningful activity. The focus of increasing patient participation in care is morally correct and indicated by evidence of increasing engagement in rehabilitation. Involving the patient in goal setting was found to give patients a sense of ownership for their goals. Setting both short-term and long-term goals is more effective than setting only long term goals (Wade, 1998). In my clinical experience I know it is very important in practice to link goals one to another so the patient can see the connection between long-term aspirations and the more immediate suggested rehabilitation goals. In goal setting it is important to document any goals set and to

The central idea is that goals affect performance by focusing attention, directing effort, increasing motivation and enabling the development of strategies to achieve one’s objectives (Hurn et al., 2006). Rehabilitation involves altering the behaviour of people including patient, family, carers and members of the treating team. Rehabilitation in stroke is a progressive, goal-orientated process aimed at enabling a person with impairment to reach his or her optimal physical, cognitive, emotional and social functioning level (Heart and Stroke Foundation of Ontario, 2007). Behaviour can be described as goal directed activity and controlling or changing behaviour is easiest to achieve if the patient wishes to achieve the new or altered goal and if the rehabilitation team have a consistent approach to assist the patient achieve their desired goal (Wade, 1998). In my clinical experience I have found it more likely that members of the team will act in a coordinated and more consistent way if goals are commonly shared. Setting goals ensures important actions are not overlooked. The process of goal setting is seen as one of the key skills to characterise professionals working in rehabilitation (Wade, 1998). The value of goal setting for interdisciplinary teamwork is undoubted (Schut and Stam, 1994) and rehabilitation