national-clinical-guidelines-for-stroke-fourth-edition
national-clinical-guidelines-for-stroke-fourth-edition
national-clinical-guidelines-for-stroke-fourth-edition
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E have protocols to guide the use of more complex assessment tools, describing:<br />
● when it is appropriate or necessary to consider their use<br />
● which tool(s) should be used<br />
● what specific training or experience is needed to use the tool(s)<br />
F measure (change in) function at appropriate intervals.<br />
3.11.2 Sources<br />
A–B Consensus<br />
C Consensus (Wade 1998; Wikander et al 1998)<br />
D–F Consensus<br />
3.11.3 Implications<br />
In the absence of any <strong>national</strong> guidance or requirement, this will require individual<br />
services to undertake some work on making choices and developing protocols. However,<br />
this process is likely to lead to the selected tools and developed protocols being used,<br />
whereas imposed guidance rarely succeeds. Appropriate use should improve effectiveness<br />
and efficiency, covering the costs of additional training of staff that may be needed.<br />
3.12 Goal setting<br />
Goal setting can be defined as the identification of and agreement on a behavioural target<br />
which the patient, therapist or team will work towards over a specified period of time.<br />
The setting of goals is central to effective and efficient rehabilitation. This section focuses<br />
on goal setting in <strong>stroke</strong> rehabilitation.<br />
3.12.1 Recommendations<br />
Every patient involved in the rehabilitation process should:<br />
3 Organisation of <strong>stroke</strong> services<br />
A have their feelings, wishes and expectations established and acknowledged<br />
B participate in the process of setting goals unless they choose not to or are unable to<br />
participate because of the severity of their cognitive or linguistic impairments<br />
C be given help to understand the nature and process of goal setting, and be given help<br />
(eg using established tools) to define and articulate their personal goals<br />
D have goals that:<br />
● are meaningful and relevant to the patient<br />
● are challenging but achievable<br />
● include both short-term (days/weeks) and long-term (weeks/months) targets<br />
● include both single clinicians and also the whole team<br />
● are documented, with specified, time-bound measurable outcomes<br />
● have achievement evaluated using goal attainment<br />
● include carers where appropriate<br />
● are used to guide and in<strong>for</strong>m therapy and treatment.<br />
© Royal College of Physicians 2012 31
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