‘Finding a Balance’ in Involving Patients in Goal Setting Early After Stroke: A Physiotherapy Perspective

Abstract

Collaborative goal setting (between patient and professional) confers benefits within stroke and neurological rehabilitation, and is recommended in clinical guidelines. However, evidence suggests that patient participation in rehabilitation goal setting is not maximized, particularly within the hospital setting. The purpose of this study was to investigate physiotherapists' perceptions about their experiences of collaborative goal setting with patients in the sub-acute stages after stroke, in the hospital setting. This qualitative study employed constructivist grounded theory methodology. Nine physiotherapists, of varying experience, were selected using purposive then theoretical sampling from three National Health Service hospital stroke units in England. Semi-structured interviews were conducted, audio-recorded and transcribed. Transcripts were coded and analysed using the constant comparative method of grounded theory to find common themes. Three themes emerged from the data: 1) 'coming to terms with stroke' - the individual patient journey; 2) the evolution of goal setting skill - the individual physiotherapist journey; and 3) 'finding a balance' - managing expectations and negotiating interactions. A provisional grounded theory was constructed, which highlighted that, from the physiotherapists' perspective, collaboration with patients within goal setting early after stroke involved finding a balance between numerous different drivers, which have the potential to compete. Patient-directed and therapist-directed goal setting approaches could be viewed as opposite ends of a continuum, along which patient-centred goal setting is possible. Physiotherapists perceived that collaborating with patients in goal setting was important but challenging. Goal setting interactions with other professionals, patients and families were perceived as complex, difficult and requiring significant effort. The importance of individuality and temporality were recognized suggesting that the goal setting approach needs to be adapted to the context and the individuals involved.