Goal setting in community based stroke rehabilitation: Is where we are at where we want to be?

Transcription

1 Goal setting in community based stroke rehabilitation: Is where we are at where we want to be? UK Stroke Forum, 2016 Dr Lesley Scobbie Stroke Association HRH The Princess Margaret Clinical Lecturer (Glasgow Caledonian University); Occupational Therapist (NHS Forth Valley) Collaborators: Prof Marian Brady, Dr Edward Duncan, Prof Sally Wyke, Dr Diane Dixon

2 Outline of presentation Background The Goal setting & Action Planning (G-AP) framework: An overview Understanding community stroke rehabilitation contexts and routine goal setting practice: UK wide survey G-AP Vs routine practice: the same or different? Implications for research and practice

3 Background Stroke causes more complex disability than any other condition (Adamson, Journal of Stroke & Cerebrovascular Diseases 2004) 46% of stroke survivors require ongoing community rehabilitation (Sentinel Stroke National Audit Programme; National Results, 2015) Goal setting recommended in stroke clinical guidelines (Scottish Intercollegiate Guidelines Network 2010; Royal College of Physicians 2016) Stroke survivors living at home have important goals they hope to achieve (Struggling to Recover, Stroke Association 2012) However, many report unmet needs & emotional difficulties (Unmet needs Survey; Stroke Association 2010)

4 The G-AP framework: An overview

5 Why develop a practice framework? Theory based goal setting practice framework Key stages How it works Replicable Testable Optimise goal setting practice Patient centred Theory/ evidence based Team approach Optimise stroke survivor recovery Goal attainment Rehabilitation outcomes Development and Evaluation

6 Theories relevant to the goal setting process Goal Setting Theory (Latham & Locke); Health Action Process Approach (Schwarzer; Sniehotta); Social Cognition Theory (Bandura) Common constructs Motivational phase Development of goal intentions Goal setting Action phase Initiation & maintenance of goal behaviour Self efficacy Outcome expectancies Goal specificity Goal difficulty Plans Appraisal/ Feedback (Scobbie et al, Clinical Rehabilitation, 23(4) 2009)

7 G-AP: Two case study examples Scobbie, L., et al. (2011) Clinical Rehabilitation; 25(5). Scobbie, L., et al. (2013) BMC Health Services Research; 13(190).

8 G-AP Framework Jenny I'm not talking clearly; get back to work Phone local pool to find out weekend swim times Coping Plan Bullet point list Confidence 9/10 Phoned the pool as planned Speak clearly on the phone G-AP SS held record Discuss and agree on next action plan to work towards set goal Praise success self efficacy Incremental skill improvement Jenny managed phone call, Felt good about it

9 G-AP Framework Pete Getting back to work is really important Sit driving assessment Coping Plan No barriers Confidence 10/10 Sat driving assessment as planned Get back to driving Decide not to pursue driving goal for the time being Provide support Understand and accept limitations Goal reappraisal Info not coming in quick enough Disappointed

10 Evaluate G-AP Vs usual GS practice Research Questions: I. What is the nature of community rehabilitation contexts in which G-AP could be delivered? II. What does usual goal setting practice look like in these settings?

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12 Service responses n= 437 Scotland:118 (27%) England: 279 (64%) N Ireland: 9 (2%) Wales: 31 (7%)

13 Q What title best describes your team? Other 13% Bespoke team 11% Reablement team 5% Hospital based outreach 6% Combined CRT/EDS 17% Community Rehabilitation Team (CRT) 36% Early Supported Discharge Team (ESD) 12% % Teams (n=427)

14 Q What types of patients are seen by your team? (n=437) 29% Stroke patients only (n=124) 71% Mixed patient group (n=312)

15 Unidisciplinary V multidisciplinary teams? Unidisciplinary (n=72) Multidisciplinary (n=335) 18% 82%

16 Q What professional groups are represented in your team? Other Doctor Social Worker Psychology Dietician 22% 19% 20% 24% 26% Nurse 44% Speech and Language Therapist Rehabilitation Assistant 64% 70% Occupational Therapist Physiotherapist % Teams (n=407) 84% 86%

17 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Q. Is goal setting used by your team with people recovering from stroke? (n=395) 91% 8% 1% All/ most Some None

18 Q Which method (if any) does your team use to guide goal setting practice?* Other 13% G-AP Framework 2% Canadian Occ Perf Measure 17% Goal Attainment Scaling Own method (team) 25% 24% Own method (health professional) 37% No method * 25% of services reported use of 2 or more methods % Teams (n=315) 26%

19 Methods used to guide goal setting practice (n=380) 18% 17% 39% 26% Formal Informal Mixed No methods

20 Routine use of goal setting activities Copy of goals & plans Downgrade/ Disengage Feedback Appraisal Confidence to complete plan Coping plans Action Plans Set specific goals Find out patient priorities % Teams

21 Routine goal setting practice 98% 93%% 62% 60% Coping Plan 68% 36% Confidence Confidence 59% 87% 92% Accessible record of goals & plans 39%

22 Summary G-AP is designed to optimise goal setting practice & stroke survivor recovery in community rehabilitation settings There is strong theoretical rationale and developing evidence base to support inclusion of key stages of G-AP in practice Teams delivering stroke rehabilitation in the community are complex (e.g. service model; staff profile; patient mix) Usual goal setting practice is highly variable & potentially suboptimal (e.g. planning, goal adjustment; accessible copy of goals/ plans)

23 Implications for research & practice Does G-AP offer any added value over usual goal setting practice effectiveness How can G-AP (or any other goal setting intervention) be delivered in different team settings with individual stroke survivors implementation Goal attainment and goal adjustment can enhance recovery outcomes

24 Any Questions? PLEASE CONTACT ME IF YOU WOULD LIKE A COPY OF THE SLIDES

25 References Stroke Association: State of the Nation Stroke Statistics; London, Royal College of Physicians: Sentinel Stroke National Audit Programme; National Results, 2016 ( Adamson J et al. Is stroke the commonest cause of disability? Journal of Stroke & Cerebrovascular Diseases 2004;13(4): Feigin VL et al. Lancet Jan 18;383(9913): Stroke Association: Struggling to recover, Stroke Association: Unmet needs survey, Royal College of Physicians. National Clinical Guidelines for Stroke 5th Edition SIGN 118 Guidelines: Management of patients with stroke: Rehabilitation, prevention and management of complications, and discharge planning. Scottish Intercollegiate Guidelines Network. Scobbie, L. et al. Identifying and applying psychological theory to setting and achieving rehabilitation goals. Clinical Rehabilitation; 2009; 23: Scobbie L. et al. Goal-setting and action planning in the rehabilitation setting: development of theoretically informed practice framework. Clinical Rehabilitation; 2011, 25: Scobbie, L. et al. Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation. BMC Health Services Research 2013, 13:190. Scobbie L. et al. Goal setting practice in services delivering community-based stroke rehabilitation: A United Kingdom (UK) wide survey. Disability & Rehabilitation. 2015; 37(14)