Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke

Barnden, Rebecca; Cadilhac, Dominique A.; Lannin, Natasha A.; Kneebone, Ian; Hersh, Deborah; Godecke, Erin; Stolwyk, Renerus J.; Purvis, Tara; Nicks, Rebecca; Farquhar, Michelle J.; Gleeson, Stephanie; Gore, Carol; Herrmann, Kelsie; Andrew, Nadine E.

doi:10.1016/j.pecinn.2021.100008

Cited by 7 publications

(10 citation statements)

References 41 publications

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“…The intervention comprises a revised 34‐item goal‐setting menu, which includes more specific categories related to emotional challenges poststroke, an area highlighted by respondents as lacking in the original version (Phase I). The revised goal‐setting menu is supported by a newly developed 120‐page manual containing: guideline summaries; common goals; goal metrics based on the SMART Goal Evaluation Method (SMART‐GEM); evidence‐based strategies and worked examples 52 . As a consequence of the feedback received by participants on their experience, the frequency of messages per goal is similar to the Phase I trial, but there is the option for participants to select up to five goals.…”

Section: Discussionmentioning

confidence: 99%

“…The specific feedback from participants related to their experience during this pilot study has reiterated the importance of testing the effectiveness of the self-management support programme earlier in the stroke recovery continuum, and over a longer period. We have used this feedback to modify the protocol for our fully powered RCT, 51 52 As a consequence of the feedback received by participants on their experience, the frequency of messages per goal is similar to the Phase I trial, but there is the option for participants to select up to five goals. Messages are being sent via SMS or email, depending on personal preference.…”

Section: Discussionmentioning

confidence: 99%

“…The revised goal‐setting menu is supported by a newly developed 120‐page manual containing: guideline summaries; common goals; goal metrics based on the SMART Goal Evaluation Method (SMART‐GEM); evidence‐based strategies and worked examples. 52 As a consequence of the feedback received by participants on their experience, the frequency of messages per goal is similar to the Phase I trial, but there is the option for participants to select up to five goals. Messages are being sent via SMS or email, depending on personal preference.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Mixed methods evaluation to explore participant experiences of a pilot randomized trial to facilitate self‐management of people living with stroke: Inspiring virtual enabled resources following vascular events (iVERVE)

Purvis

Busingye

Andrew

et al. 2022

Health Expectations

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Introduction Despite digital health tools being popular for supporting self‐management of chronic diseases, little research has been undertaken on stroke. We developed and pilot tested, using a randomized controlled design, a multicomponent digital health programme, known as Inspiring Virtual Enabled Resources following Vascular Events (iVERVE), to improve self‐management after stroke. The 4‐week trial incorporated facilitated person‐centred goal setting, with those in the intervention group receiving electronic messages aligned to their goals, versus limited administrative messages for the control group. In this paper, we describe the participant experience of the various components involved with the iVERVE trial. Methods Mixed method design: satisfaction surveys (control and intervention) and a focus group interview (purposively selected intervention participants). Experiences relating to goal setting and overall trial satisfaction were obtained from intervention and control participants, with feedback on the electronic message component from intervention participants. Inductive thematic analysis was used for interview data and open‐text responses, and closed questions were summarized descriptively. Triangulation of data allowed participants' perceptions to be explored in depth. Results Overall, 27/54 trial participants completed the survey (13 intervention: 52%; 14 control: 48%); and 5/8 invited participants in the intervention group attended the focus group. Goal setting : The approach was considered comprehensive, with the involvement of health professionals in the process helpful in developing realistic, meaningful and person‐centred goals. Electronic messages (intervention) : Messages were perceived as easy to understand (92%), and the frequency of receipt was considered appropriate (11/13 survey; 4/5 focus group). The content of messages was considered motivational (62%) and assisted participants to achieve their goals (77%). Some participants described the benefits of receiving messages as a ‘reminder’ to act. Overall trial satisfaction : Messages were acceptable for educating about stroke (77%). Having options for short message services or email to receive messages was considered important. Feedback on the length of the intervention related to specific goals, and benefits of receiving the programme earlier after stroke was expressed. Conclusion The participant experience has indicated acceptance and utility of iVERVE. Feedback from this evaluation is invaluable to inform refinements to future Phase II and III trials, and wider research in the field. Patient or Public Contribution Two consumer representatives sourced from the Stroke Foundation (Australia) actively contributed to the design of the iVERVE programme. In this study, participant experiences directly contributed t...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mixed methods evaluation to explore participant experiences of a pilot randomized trial to facilitate self‐management of people living with stroke: Inspiring virtual enabled resources following vascular events (iVERVE)

Purvis

Busingye

Andrew

et al. 2022

Health Expectations

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“…The inclusion and exclusion criteria are described in Table 1. 19,20 The package supported the setting of personcentred goals according to the SMART (Speci c, Measurable, Achievable, Realistic, Timely) criteria 21,22 to support reliable measurement of attainment using Goal Attainment Scaling (GAS). 21 For each clinician, the goals developed with their rst ve participants were externally rated for quality using the Smart Goal Evaluation Method (Smart-GEM), 23 by an independent clinical expert.…”

Section: Patient Recruitmentmentioning

confidence: 99%

“…The manual included a summary of best clinical practice recommendations for each goal, 30 the goal metrics and worked examples of goals illustrating conformity with the SMART metrics. 19,20 A summary sheet of the completed goals was then provided to the participant.…”

Section: Interventionsmentioning

confidence: 99%

A mixed-method feasibility study of a new digital health support package for people after stroke: The Recovery-focused Community support to Avoid readmissions and improve Participant are Stroke (ReCAPS) intervention

Cameron

Lannin

Harris

et al. 2022

Preprint

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Background: Evidence for digital health programs to support people living with stroke is limited. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention. Method: We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults discharged home within 10 days of hospital admission, modified Rankin Score 0-4, and prior use of Short Message System (SMS) or email. While in hospital participants contributed to structured person-centred goal setting with clinicians, provided responses to surveys including assessment of self-management skills and health-related quality of life. Participants were randomised 7-14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week program of personalised electronic support messages (average 66 messages sent by SMS or email) aligned to their goals. The control group received six electronic administrative messages. Feasibility outcomes included: number of patients screened and recruited, study retainment, completion of outcome measures, number of electronic messages delivered, and acceptability of the ReCAPS intervention and trial procedures (participant satisfaction survey, clinician interviews and researcher communications). We undertook inductive thematic analysis of interview/open-text survey data, and descriptive analysis of closed survey questions.Results: Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Outcome assessments at 12-weeks were completed by 88% of participants with 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting acceptable, they raised concerns regarding the additional time required to personalise goals. Conclusion: The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the Phase III trial to reduce the burden on hospital clinicians. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12618001468213 (Date 31/08/2018); Universal Trial Number: U1111-1206-7237

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Comparison of standard goal attainment scaling (GAS) and the GAS-light method for evaluation of goal attainment during neurorehabilitation of the upper limb

Pike,

Cusick,

Turner-Stokes

et al. 2024

The Journal of the International Society of Physical and Rehabilitation Medicine

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Background: Goal attainment scaling (GAS) is now widely used as a person-centered measure of outcome from rehabilitation and has demonstrated validity in diverse populations with sensitivity to change. However, as originally described, it is time-consuming for use in busy clinical settings. The “GAS-light” is a simplified version designed for application in routine clinical practice. Although increasingly taken up by clinicians, published evidence of the validity of GAS-light method is currently lacking. Objective: To evaluate the validity and sensitivity of the GAS-light rating method as a measure of goal attainment in clinical neurorehabilitation practice. To examine its agreement with the standard GAS rating (as originally described by the developers) as the gold standard and to assess its clinical utility and acceptability. Methods design: A direct, head-to-head comparison of the 2 GAS rating methods in a cohort of adults undergoing upper limb motor rehabilitation programs across a range of rehabilitation settings, including hospital, community outpatient, and spasticity clinic services. Study population: 60 patients (n=54 poststroke) set a total of 136 goals (range 1–4 per patient). In this comparative study, patients acted as their own controls. Measures: The 2 rating methods were applied independently and in parallel from a single goal-setting discussion. Goal attainment was measured on the original 5-point GAS using a predetermined follow-up guide and the GAS-light with its 6-point verbal rating scale. The evaluation included concurrent validity (intraclass correlation coefficients and agreement between the 2 ratings) and sensitivity to change using the standardized response mean (SRM). Thirteen clinicians and 52 participants completed surveys of clinical utility and patient acceptance, respectively. Results: Individual absolute agreement of 2-way mixed-effects intraclass correlation between the tools indicated good agreement (ICC(A,1)=0.88, 95% CI: 0.80, 0.93), and small systematic bias (–1.72 (95% CI: −3.04, −0.41). Both tools measured similar levels of change over time (GAS SRM=1.79; GAS-light SRM=1.62). Clinicians perceived GAS-light had stronger clinical utility, being quicker and easier to administer, score, and understand. Patients perceived GAS-light as acceptable, comfortable, worthwhile, and helpful. Conclusions: GAS-light is reliable and sensitive to change, with better clinical utility than the standard GAS. Either tool may be used to assess goal attainment in clinical upper limb neurorehabilitation.

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Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke

Cited by 7 publications

References 41 publications

Mixed methods evaluation to explore participant experiences of a pilot randomized trial to facilitate self‐management of people living with stroke: Inspiring virtual enabled resources following vascular events (iVERVE)

Mixed methods evaluation to explore participant experiences of a pilot randomized trial to facilitate self‐management of people living with stroke: Inspiring virtual enabled resources following vascular events (iVERVE)

A mixed-method feasibility study of a new digital health support package for people after stroke: The Recovery-focused Community support to Avoid readmissions and improve Participant are Stroke (ReCAPS) intervention

Comparison of standard goal attainment scaling (GAS) and the GAS-light method for evaluation of goal attainment during neurorehabilitation of the upper limb

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