School of Rehabilitation Therapy, Queen's University, Toronto, Canada.
Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
Clin Rehabil. 2022 Dec;36(12):1694-1704. doi: 10.1177/02692155221121006. Epub 2022 Aug 25.
Identify, map, and synthesize existing reviews, to extract and analyse the most prominent barriers and facilitators to applying patient-centred goal-setting practice in rehabilitation using the Capability, Opportunity Motivation Behaviour (COM-B) model.
Scoping review.
A primary search was conducted in MEDLINE, CINAHL, EMBASE, PsychInfo, and Cochrane. Citation chaining was employed.
All types of review (systematic, scoping, and narrative) studies published up to June 14, 2022 that included physical and neurological rehabilitation, patient-centeredness, and goal-setting were reviewed. Studies were scrutinized for relevance, quality was not assessed. The most prominent barriers and facilitators were synthesized using thematic content analysis and mapped onto the COM-B model.
Twenty-six review studies covering a range of conditions and settings, acute to community were included. Barrier and facilitators were identified at patient, provider, and organizational level. Barrier themes include provider's existing beliefs about goal-setting, lack of skills, and integration into clinical routines. Patient barriers related to capacity and opportunity to participate. Organizational barriers include lack of clinical guidelines, patient preparation, insufficient provider time, and high productivity expectations. Facilitators included goal-setting guidelines, training and education of providers and patients, revised clinical routines, performance monitoring, adequate time, and resources.
Healthcare providers should be the primary target of intervention. A provider's motivation to change current practice is the most prominent barrier, followed closely by capacity and opportunity. Patients require information, training, and structured engagement opportunities. Organizations play a key role in creating the optimal environmental conditions to enable patient-centred goal-setting.
利用能力、机会、动机-行为（COM-B）模型，识别、绘制和综合现有的综述，以提取和分析康复中应用以患者为中心的目标设定实践的最突出障碍和促进因素。
范围综述。
在 MEDLINE、CINAHL、EMBASE、PsychInfo 和 Cochrane 中进行了初步搜索。采用引文连锁。
审查了截至 2022 年 6 月 14 日发表的所有类型的综述（系统综述、范围综述和叙述性综述）研究，包括物理和神经康复、以患者为中心和目标设定。研究的相关性进行了审查，未评估质量。使用主题内容分析对最突出的障碍和促进因素进行综合，并映射到 COM-B 模型上。
共纳入了 26 项综述研究，涵盖了各种疾病和环境，从急性到社区。在患者、提供者和组织层面确定了障碍和促进因素。障碍主题包括提供者对目标设定的现有信念、缺乏技能和将其整合到临床常规中。患者的障碍与参与的能力和机会有关。组织障碍包括缺乏临床指南、患者准备、提供者时间不足和高生产力期望。促进因素包括目标设定指南、对提供者和患者的培训和教育、修订临床常规、绩效监测、充足的时间和资源。
医疗保健提供者应成为干预的主要目标。提供者改变当前实践的动机是最突出的障碍，其次是能力和机会。患者需要信息、培训和结构化的参与机会。组织在创造最佳环境条件以实现以患者为中心的目标设定方面发挥着关键作用。
