Quality standard

Quality statement 6: Regular review of rehabilitation goals

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

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

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: Data can be collected from information recorded locally by healthcare provider organisations, for example, from clinical or service protocols.

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: Data is collected using the Sentinel Stroke National Audit Programme (SSNAP) core dataset question 4.7 and reported in the results of the clinical audit.

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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

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

Data source: Data can be collected from information collected locally by healthcare professionals and provider organisations, for example, from patient surveys. The SSNAP clinical audit includes a quality-of-life measure (EuroQoL EQ-5D-5L) at the 6‑month post-stroke follow up.

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

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

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 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. NICE guideline NG236 (2023), recommendation 1.2.11

Definitions of terms used in this quality statement

Rehabilitation goals

Goals for rehabilitation for people after a stroke should:

  • be meaningful and relevant to them

  • focus on activity and participation

  • be challenging but achievable

  • include both short- and long-term elements.

[NICE's guideline on stroke rehabilitation in adults, recommendation 1.2.7]

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 and held regularly, involve the person after stroke and, where appropriate, their family members and carers, in discussions. [NICE's guideline on stroke rehabilitation in adults, recommendations 1.2.8 and 1.2.11, 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.