Patient-centered goal-setting in stroke rehabilitation: a scoping review

TL;DR

This study reviews how patient-centered goal-setting is used in stroke rehabilitation and finds that it is inconsistently applied with gaps in coordination and evaluation.

Contribution

The study identifies gaps in cross-sector coordination and evaluation in patient-centered goal-setting for stroke rehabilitation.

Findings

Patient-centered goal-setting in stroke rehabilitation is practiced variably without consistent procedures.

Evaluation procedures and cross-sector coordination are rarely described in the literature.

Goal-setting processes mainly occur at the beginning of rehabilitation with limited monitoring.

Abstract

Patient-centered goal-setting is an important part of the rehabilitation process. The guidelines for stroke rehabilitation in adults recommend setting goals that are meaningful and relevant for the patient, focusing on activity and participation, and involving the patient. Patient-centered goal-setting is to improve rehabilitation outcomes. However, patient-centered goal-setting occurs partly or not at all. There is also a lack of continuity in goal-setting across sectors.

This study aimed to identify existing research-based knowledge on procedures used in patient-centered goal-setting processes in stroke rehabilitation.

A scoping review was conducted by searching PubMed, CINAHL Complete, EMBASE, APA PsycINFO, Scopus, and Cochrane databases for studies involving adults receiving or clinicians delivering stroke rehabilitation and focusing on patient-centered goal-setting processes. The included studies were analyzed using inductive content analyses and linked to five domains in goal-setting processes: person-centeredness, collaboration with healthcare professionals and patients, coordination across sectors, monitoring, and evaluation.

Eighteen studies were included. Inductive content analysis identified elements related to goal-setting processes, mainly occurring at the beginning of the rehabilitation. Linking the studies to five domains revealed gaps in cross-sectoral coordination, monitoring, and evaluation.

Patient-centered goal-setting in stroke rehabilitation is practiced variably, and there is no overall agreement about the procedures to ensure that goal-setting is patient-centered. Therapist- and team-led goal-setting processes are used. Evaluation procedures and cross-sectoral coordination are rarely described.

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