A multinational online survey of the goal setting practice of rehabilitation staff with stroke survivors with aphasia

Figures & data

Figure 1. Content analysis procedure.

Table 1. Respondent demographics; total responses: n = 251.

Demographic	Response	n (%)
Country	UK	89 (35)
	Aotearoa New Zealand	61 (24)
	Ireland	47 (19)
	Australia	34 (14)
	Canada	20 (8)
Respondent’s clinical role	Speech and language therapist	118 (47)
	Occupational therapist	58 (23)
	Physiotherapist	53 (21)
	Rehabilitation assistant	9 (4)
	Clinical psychologist/neuropsychologist	4 (1)
	Other*	9 (4)
Clinical setting *multiple response	Hospital inpatient (acute or rehabilitation)	154 (61)
	Patient’s own home (community/domiciliary care, outreach, early supported discharge)	103 (41)
	Outpatient clinic or day unit	72 (29)
	Residential care setting/nursing home	37 (15)
	Other ^$	7 (3)
Years of experience working with stroke survivors	<1 year	15 (6)
	2–4 years	45 (18)
	5–9 years	58 (23)
	>10 years	133 (53)
Team type	Multidisciplinary	218 (87)
	Not part of a team	15 (6)
	Unidisciplinary	9 (4)
	Interdisciplinary	6 (2)
	Other	3 (1)
Other roles in respondent’s team*multiple response	Physiotherapist	210 (84)
	Occupational therapist	198 (79)
	Rehabilitation assistant	194 (77)
	Nurse	185 (74)
	Speech and language therapist	180 (72)
	Dietician	160 (64)
	Doctor	158 (63)
	Social worker	154 (61)
	Clinical psychologist/neuropsychologist	135 (54)
	Music or recreation therapist	40 (16)
	Optometrist/orthoptist	11 (4)
	Other^£	32 (13)

Key: * = nurse; dietician; doctor; service manager; assistant psychologist; case manager; stroke recovery co-ordinator; $ = university clinics; community gym and aquatic centre; council building stroke unit; primary care; £ = e.g., stroke co-ordinators, needs assessor, discharge co-ordinator

Figure 2. Extent of goal setting with stroke survivors with aphasia.

Table 2. Goal-setting methods* used with stroke survivors with aphasia.

Goal-setting method (n = 244)	Total (%)
SMART goals	118 (48)
Goal Attainment Scaling (GAS)	47 (19)
Canadian Occupational Performance Measure (COPM)	31 (13)
Goal setting and Action Planning framework (G-AP)	11 (4)
SMARTER framework	21 (9)
Own method	22 (9)
Team’s own method	33 (14)
Other	31 (13)
No method	110 (45)
Total	244

Key: * = multiple response options

Figure 3. Reported frequency of goal-setting activities (n = 244).

Figure 4. Staff self-rated confidence goal setting with stroke survivors with and without aphasia.

Figure 5. Reported barriers to goal setting with stroke survivors with aphasia.

Figure 6. Reported facilitators supporting goal setting with stroke survivors with aphasia.

Table 3. Reported topics in training received on generic goal setting, aphasia-specific goal setting, and communication skills.

Generic goal setting (n = 161 received training)		n (%)
	Developing targeted goals (e.g., SMART goals)	128 (78%)
	How to work collaboratively with patients and families to set personally meaningful goals	108 (67%)
	Using a goal-setting method (e.g., COPM or GAS)	104 (65%)
	Negotiating patient expectations/ hopes/disappointment	83 (52%)
	Adjusting goals and action plans according to progress	82 (51%)
	Other	14 (9%)
Aphasia-specific goal setting (n = 67 received training)		n (%)
	Communication strategies	61 (91%)
	How to make written information accessible	48 (72%)
	How to use a specific communication tool	39 (58%)
	How to adapt a goal-setting method (e.g., GAS or COPM)	26 (39%)
	Other	3 (5%)
Communication partner skills (n = 160 received training)		n (%)
	Strategies for communicating with stroke survivors with aphasia	152 (95%)
	Information about aphasia and how it impacts on communication	145 (91%)
	Conversation Partner Training (e.g., SCA)	95 (59%)
	How to support family members/carers of stroke survivors with aphasia	98 (61%)
	How to make accessible resources (e.g., patient education materials)	94 (59%)
	Other	5 (3%)

Table 4. Theme 1 summary: It depends on the stroke survivor.

Theme	Categories	Sub-categories	Supporting quotes
It depends on the stroke survivor	Goal setting is more challenging with aphasia	Aphasia itself is a barrier	“Although I try to work closely with the SLT/OT re goal setting, I do find it challenging when the client has aphasia”. (R11, PT, ANZ)
		Aphasia presentation	“It can be difficult to accessibly explain what you want to achieve and what they need to think about, particularly if their aphasia is receptive in nature”. (R30, SLT, UK)
	Issues beyond aphasia can affect goal setting	Emotional and psychological readiness for goal setting	“I’ve worked with people who are ready to set goals only a few days after their stroke. But sometimes I’ve found that an individual may be ready much later in their journey, particularly if their journey has been complicated”. (R16, SLT, ANZ)
		Medical and cognitive issues	“I think patients with reduced insight will always have trouble setting goals”. (R131, SLT, AUS) “Early goals have to be anticipated if patients are medically not stable”. (R132, SLT, UK)
		Stroke survivor goal expectations	“Patients often just ‘want to get better’ and can be hard to encourage them to be more specific”. (R173, SLT, ANZ)

Key: R = respondent (e.g., R1 = Respondent 1); SLT = speech and language therapist; OT = occupational therapist; PT = physiotherapist; AUS = Australia; UK = United Kingdom; IRE = Ireland; CAN = Canada; ANZ = Aotearoa New Zealand

Table 5. Theme 2 summary: Involving stroke survivors, family, and others is challenging but important.

Theme	Categories	Sub-categories	Supporting quotes
Involving stroke survivors, family, and others is challenging but important	Using a person-centred approach	Building rapport and understanding patient context	“I think it is important to involve family and get good robust history of communication style, occupational info, likes, dislikes, preferences, beliefs”. (R33, SLT, IRE)
		Clear communication about goal setting is difficult but possible	“[Goal setting] can initially be a new concept to a client and there is a lot of work that goes into helping a client understand what goal setting is”. (R11, PT, ANZ) “It can be difficult for person to give clear feedback when their verbal responses are limited”. (R197, PT, ANZ)
		Guiding the stroke survivor without dictating	“Despite the effort and time taken to facilitate communication of goals from the client, there are times where I wonder whether I have inadvertently prompted the client to set goals which, although relevant, may not be their most important goal”. (R45, SLT, ANZ)
	Working with family and others can help or hinder	Family can be an important facilitator	“If we are unable to set goals in the first session, we ask the family/ client to try and establish them at home and bring to the next session”. (R23, PT, ANZ)
		Family members can dominate the process	“Sometimes family members have been more verbal and opinionated than at other times, so it is about managing this to make sure the person with aphasia is heard most clearly”. (R218, SLT, AUS)
		Working with interpreters can be challenging	“Where English is a second language … I am unsure that the interpreting is accurate (family members or young children)”. (R184, PT, ANZ)

Key: R = respondent (e.g., R1 = Respondent 1); SLT = speech and language therapist; OT = occupational therapist; PT = physiotherapist; AUS = Australia; UK = United Kingdom; IRE = Ireland; CAN = Canada; ANZ = Aotearoa New Zealand

Table 6. Theme 3 summary: Working environment makes a difference.

Theme	Categories	Sub-categories	Supporting quotes
Working environment makes a difference	Setting andresources	Access to a quiet setting	“Access to treatment room which is quiet/minimised distractions”. (R131, SLT, AUS)
		Access to communication resources	“Access to technology for therapists and patients. Patients can borrow iPads if needed. This was very useful during Covid19 period”. (R98, SLT, CAN)
	Team working	Lack of multidisciplinary team goal setting is a barrier	“I’m confident in developing communication and swallowing goals, but not ones that involve other disciplines, physio, OT, etc”. (R93, SLT, NZ) “We do not have MDT goal setting with patients and family”. (R39, SLT, UK)
		Working in a team helps confidence	“I’m lucky enough to be in a team who have a good goal-setting protocol (SEIQoL and GAS goals) which are [used] as a regular part of our practice with every patient”. (R225, SLT, ANZ)
		Working with SLTs is a facilitator	“When it is difficult, often default to SLT or we do it jointly”. (R77, OT, UK)
	Time	Time is a facilitator	“I think you accept that goal setting with someone with aphasia may not be as efficient … but if you prioritise the time it makes your therapy a lot easier”. (R219, SLT, AUS)
		Time limitations are a barrier	“The provision of inadequate time to appropriately set goals by the service is a significant barrier. e.g., the service may set an outcome indicator of goals set within 1–2 sessions which is often not possible with someone with severe aphasia”. (R25, SLT, AUS)