Quality statement 6: Regular review of rehabilitation goals

Quality statement

Adults who have had a stroke have their rehabilitation goals reviewed at regular intervals. [2010, updated 2016]

Rationale

Regularly reviewing the goals of an adult who has had a stroke helps to identify their values, beliefs and preferences, which may affect the kind of rehabilitation that would be suitable for them. It may also help to encourage and motivate the person, and improve the outcomes of rehabilitation. Goals should be set within 5 days of arrival at an accident and emergency (A&E) department to ensure they are established from the start of the rehabilitation process. They should then be reviewed at regular intervals to ensure that the goals are still relevant to the person who has had a stroke.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults who have had a stroke have their rehabilitation goals reviewed at regular intervals.

Data source: Local data collection.

Process

a) Proportion of adults who have had a stroke who have their rehabilitation goals agreed within 5 days of arrival at A&E.

Numerator – the number in the denominator who have their rehabilitation goals agreed within 5 days of arrival at A&E.

Denominator – the number of adults who have had a stroke.

Data source: Local data collection. Data can be collected using the Royal College of Physicians' Sentinel Stroke National Audit Programme (SSNAP) question 4.7.

b) Proportion of adults who have had a stroke who have their rehabilitation goals reviewed at regular intervals.

Numerator – the number in the denominator who have their rehabilitation goals reviewed at regular intervals.

Denominator – the number of adults who have had a stroke with agreed rehabilitation goals.

Data source: Local data collection.

Outcome

a) Quality of life for adults who have had a stroke.

Data source: Local data collection.

b) Readmission rates of adults who have had a stroke.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as primary, secondary and community care providers) ensure that systems are in place for adults who have had a stroke to have their rehabilitation goals reviewed at regular intervals.

Healthcare professionals review regularly the rehabilitation goals of adults who have had a stroke.

Commissioners (such as local councils, NHS England and clinical commissioning groups) ensure that they commission services in which adults who have had a stroke have their rehabilitation goals reviewed at regular intervals.

Adults who have had a stroke have the opportunity to discuss and agree goals (things they would like to achieve) for their recovery and have them reviewed regularly to ensure they are still relevant.

Source guidance

Stroke rehabilitation in adults (2013) NICE guideline CG162, recommendations 1.2.8 and 1.2.12

Definitions of terms used in this quality statement

Rehabilitation goals

Goals for rehabilitation should:

  • be meaningful and relevant to adults with stroke

  • focus on activity and participation

  • be challenging but achievable

  • include both short‑term and long‑term elements.

[NICE's guideline on stroke rehabilitation in adults, recommendation 1.2.8]

Reviewing goals at regular intervals

Goals should be set within 5 days of arrival at A&E. Reviewing goals should take place at intervals suitable to the ability of the individual and nature of the goal, such as at 6 weeks, 3 months, 6 months and annually thereafter. Reviews should take place in goal‑setting meetings that are timetabled into the working week and involve the person with stroke, and where appropriate, their family or carer.

[NICE's guideline on stroke rehabilitation in adults, recommendations 1.2.9 and 1.2.12, and expert consensus]

Equality and diversity considerations

When setting goals for rehabilitation, healthcare professionals should be aware that adults with stroke may have cognitive or physical impairments, and at the acute stage participation for some adults may be limited until the person feels ready and more confident. 

Discussion about goals should take into account any additional needs, such as physical, sensory or learning disabilities, and the needs of people who do not speak or read English. People should have access to an interpreter or advocate if needed.