Article 8: The Patient’s View of Recovery: A Tool to Enhance Rehabilitation Goal Setting

Abstract

Objective: To introduce the “preference hierarchy” as a tool to explore the personal significance of being able to perform 1 activity over another. Design: Participatory action research was used to design an imagined virtual recovery simulation procedure based on card sort methods. Resulting hierarchies established utilities while providing narrative thematic analyses. Setting: Inner-city acute inpatient rehabilitation facility. Participants: 2 patients were selected from 44 participants to illustrate clear examples of the person-specific nature of the phenomenon being investigated. Intervention: Patients organized 18 disparate functional activities such as eating, walking, and memory, according to subjectively meaningful categories. Main Outcome Measures: Preference hierarchies. Results: Whereas patient 1 stressed the importance of good problem-solving skills in remaining independent with multiple sclerosis, patient 2 saw cognitive functioning and mobility as fundamental for contributing to her daughter’s household. Grouping structures differed, based on each person’s unique life experiences and recovery preferences. Both structures, however, appear ecologically related according to when or where activities occurred. Conclusions: Values emerging during card sorts appear subject to individual life experiences. Rehabilitation clinicians could use preference hierarchies to uncover highly personal and idiosyncratic aspects of disability, thereby exposing individual goals for recovery.