Oral Presentation Smart Strokes Annual Scientific Meeting 2024

Implementing a Tailored, Co-designed Goal-setting Implementation Package in Rehabilitation Services: A multisite mixed methods study.   (106857)

Amanda Baker 1 , Petrea Cornwell 2 , Louise Gustafsson 2 , Claire Stewart 3 , Natasha Lannin 4
  1. Allied Health, Queensland Health, Sunshine Coast , Queensland, Australia
  2. School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
  3. Australasian Rehabilitation Outcome Centre, University of Woolongong, Woolongong, New South Wales, Australia
  4. Brain Recovery and Rehabilitation Group, Department of Neuroscience, Monash University, Melbourne, Victoria, Australia

Background

Elements of best practice goal-setting in rehabilitation include interdisciplinary teamwork, shared decision-making, setting specific and meaningful goals, and action planning, feedback, and goal review. These elements are inconsistently implemented in clinical practice. This study aimed to evaluate the implementation of a co-designed goal-setting package (including training modules with lived experience videos, case conference restructure, goal-boards, a key worker model, and a goal-setting workbook) to improve best-practice goal-setting in five rehabilitation services.

 

Method

Medical record audits, focus groups and lived-experience interviews were conducted pre-implementation (audits n=132, focus groups =5, interviews n=64) and post-implementation (audits n=130, focus groups =7, interviews n=56) and used to evaluate the outcome and process of implementing the co-designed goal-setting package. Quantitative data were analysed descriptively, qualitative data were inductively coded to the RE-AIM and Theoretical Domains Framework.

 

Results

Following implementation, two inpatient sites significantly improved their common goal focus (p<0.01); these sites also demonstrated a significant increase in people reporting they received copies of their rehabilitation goals (p=<0.001). Four sites improved action planning, feedback and review, and 3 sites enhanced their specificity of goal-setting. Several key factors impacted the reach, adoption, and implementation of the goal-setting package; these included the environment and processes, social influences, clinician knowledge/skill and professional roles and identity.

 

Conclusions

A rehabilitation team is a complex environment and the different teams adopted different approaches to enhance the goal-setting process with varying levels of success. The most successful mode for implementing interdisciplinary person-centred goal-setting was a team-based approach centred around the case conference format.

 

Relevance

This study highlights that best practice person-centred goal-setting can be achieved but the success of the implementation is variable across rehabilitation settings and may be influenced by the team functioning and context.

 

 

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  2. Levack WM, Dean SG, Siegert RJ, McPherson KM. Purposes and mechanisms of goal planning in rehabilitation: the need for a critical distinction. Disabil Rehabil. 2006;28(12):741-9.
  3. Scobbie L, Dixon D, Wyke S. Goal setting and action planning in the rehabilitaiton setting: development of a theoretically informed practice framework. Clinical Rehabilitation. 2011;25:468-82.
  4. Baker A, Cornwell P, Gustafsson L, Stewart C, Lannin NA. Developing tailored theoretically informed goal-setting interventions for rehabilitation services: a co-design approach. BMC Health Serv Res. 2022;22(1):811.
  5. Baker A, Cornwell P, Gustafsson L, Stewart C, Lannin NA. Implementation of best practice goal-setting in five rehabilitation services: A mixed-methods evaluation study. J Rehabil Med. 2023;55:jrm4471.
  6. Baker A, Cornwell P, Gustafsson L, Lannin NA. Implementing a tailored, co-designed goal-setting implementation package in rehabilitation services: a process evaluation. Disability and Rehabilitation. 2023:1-12.