Despite communication and cognitive impairment - person-centred goal-setting after stroke: a qualitative study

Purpose: The inclusion of rehabilitation clients with communication and/or cognitive impairments after stroke in person-centred goal-setting is challenging. Moreover, this group of clients has largely been excluded from studies, resulting in a lack of knowledge about how to optimize their participation. The aim of this study was to explore strategies that are used in rehabilitation to involve stroke survivors with communication and/or cognitive impairment in person-centred goal-setting. Materials and methods: Eleven stroke rehabilitation professionals participated in semi-structured in-depth interviews. Thematic analysis was undertaken to describe their practice-based strategies. Results: Twenty-one aspects of person-centred goal setting were described from the data and grouped according to five themes: flexibility, trusting relationships, enabling empowerment, techniques for one-to-one interaction, and involving relatives. Participants did not distinguish between approaches for clients with either communication or cognitive impairments but drew from a repertoire of strategies to best meet the individual person's needs. Participants' practice combined the conscientious and deliberate application of various strategies with a mind-set that it is possible to involve clients with communication and cognitive impairments in person-centred goal-setting. Conclusions: These findings offer insights into inclusive person-centred goal-setting practices, based on accounts from a group of experienced rehabilitation clinicians.