Attainment Of Rehabilitation Goals Research Articles

Pain self-management intervention supports successful attainment of self-selected rehabilitation goals-secondary analysis of a randomized controlled trial.

Objectives(i) Describe patients' self‐selected activity‐related rehabilitation goals, and (ii) compare attainment of these rehabilitation goals among people with persistent tension‐type neck pain receiving a group‐based pain and stress self‐management intervention (PASS) or individual physiotherapy (IPT).MethodsBefore intervention and random allocation to PASS or IPT, 156 people (PASS n = 77, IPT n = 79), listed three self‐selected activity‐related rehabilitation goals by use of the Patient Goal Priority Questionnaire (PGPQ). For each activity goal, participants rated limitations in activity performance, self‐efficacy and fear of activity performance, readiness to change to improve performance, and expectations of future activity performance. At follow‐ups (10 weeks, 20 weeks, 1 year and 2 years after inclusion), participants also responded to a question on changes made to improve activity performance. Mann–Whitney U test was used to evaluate between‐group differences.ResultsThere were between‐group differences in favour of PASS in the attainment of self‐selected rehabilitation goals with regard to activity limitations and satisfaction with activity performance at all follow‐ups.ConclusionsPASS was more successful than IPT for the attainment of self‐selected rehabilitation goals, improvements in activity limitations and satisfaction with activity performance as measured by PGPQ. The PASS programme emphasized the importance of applying active pain‐ and stress‐coping techniques in personal ‘risk situations’ for pain flare‐ups, which appear to support people with persistent tension‐type neck pain to make changes in their lives to improve activity performance.Patient or Public ContributionPatient engagement in rehabilitation by self‐selected goals was investigated, but patients were not involved in the design or conduct of the study.

Rehabilitation goals described by patients with rheumatic and musculoskeletal diseases: content and attainment during the first year after rehabilitation

Purpose We explored the content and attainment of rehabilitation goals the first year after rehabilitation among patients with rheumatic and musculoskeletal diseases. Methods Participants (n = 523) recorded goals in the Patient Specific Functional Scale at admission and reported goal attainment at admission, discharge, and 12 months after rehabilitation on an 11-point numeric rating scale. Goal content was linked to the ICF coding system and summarized as high, maintained, or no attainment. Changes in absolute scores were investigated using paired samples t-tests. Results Goals had high attainment with a significant positive change (–1.83 [95% CI −2.0, −1.65], p > 0.001) during rehabilitation, whereas goals had no attainment with a significant negative change (0.36 [0.14, 0.57], p > 0.001) between discharge and 12 months after rehabilitation. Goals focusing on everyday routines, physical health, pain management, and social or work participation were highly attained during rehabilitation. Goals that were difficult to enhance or maintain after rehabilitation addressed everyday routines, physical health, and work participation. Conclusion The positive changes in goal attainment largely occurred during rehabilitation, but they appeared more difficult to maintain at home. Therefore, rehabilitation goals should be reflected in the follow-up care planned at discharge. Implications for rehabilitation The contents of rehabilitation goals reflect the complexity and wide range of challenges patients with rheumatic and musculoskeletal diseases experience. Positive changes in goal attainment largely occur during rehabilitation and appear to be more difficult to enhance or maintain at home. Rehabilitation interventions and follow-up care should be tailored to support patients in maintaining their attained goals for healthy self-management. Rehabilitation goals should be reflected in the follow-up care planned at discharge.

Stroke early supported discharge: the impact of patients' characteristics and clinical profile on rehabilitation goal attainment and clinical outcomes

Background/aims Stroke early supported discharge services were introduced to provide a comprehensive stroke specialist therapy input, while reducing cost of acute care. Early supported discharge services resulted in better health-related outcomes. A consensus has not yet been established regarding specific early supported discharge patient characteristics and clinical profile. The main aim of this study was to establish evidence to support the development of an early supported discharge patient profile (demographics and clinical) and eligibility criteria to enable early supported discharge services achieve their purposes of reducing post-stroke disability and institutionalisation rates. This article outlines the relationship between early supported discharge patients' clinical profiles and clinical outcomes, in terms of disability, goal attainment and institutionalisation rates. Methods A retrospective review of data was implemented to determine whether specific early supported discharge patients' clinical profiles and characteristics correlate with clinical outcomes. Data were collected for patients admitted to the Suffolk Stroke Early Supported Discharge Service between August and October 2016, comprising patients' demographics and clinical profiles, including stroke type, Barthel Index and Modified Rankin Scale. Performance data were collected at the end of the early supported discharge service including therapy frequency and intensity, as well as clinical outcomes including the Goal Attainment Scale. Results Data were collected for 53 patients. Data were analysed for all patients in three groups: goals not achieved; goals achieved; and goals achieved to a higher level), according to the Goal Attainment Scale. A Chi-square test showed no significant difference with regard to sex and stroke side (P=0.27). Analysis of variance revealed no significant difference in age. Conversely, results showed a significant association between goal attainment and the stroke subtype, severity and length of hospital stay. Conclusions Specific clinical characteristics and disease profiles correlate with functional outcomes and could influence goal attainment and functional status. A specific patient cohort seems to benefit the most from early supported discharge services in terms of optimised functional outcomes and recovery.

Effectiveness of the Boston University Approach to Psychiatric Rehabilitation in Improving Social Participation in People With Severe Mental Illnesses: A Randomized Controlled Trial.

BackgroundPeople with severe mental illnesses (SMIs) have difficulty participating in society through work or other daily activities.AimsTo establish the effectiveness with which the Boston University Approach to Psychiatric Rehabilitation (BPR) improves the level of social participation in people with SMIs, in the Netherlands.MethodIn a randomized controlled trial involving 188 people with SMIs, we compared BPR (n = 98) with an Active Control Condition (ACC, n = 90) (Trial registration ISRCTN88987322). Multilevel modeling was used to study intervention effects over two six-month periods. The primary outcome measure was level of social participation, expressed as having participated in paid or unpaid employment over the past six months, as the total hours spent in paid or unpaid employment, and as the current level of social participation. Secondary outcome measures were clients’ views on rehabilitation goal attainment, Quality of Life (QOL), personal recovery, self-efficacy, and psychosocial functioning.ResultsDuring the study, social participation, QOL, and psychosocial functioning improved in patients in both groups. However, BPR was not more effective than ACC on any of the outcomes. Better social participation was predicted by previous work experience and a lower intensity of psychiatric symptoms.ConclusionsWhile ACC was as effective as BPR in improving the social participation of individuals with SMIs, much higher percentages of participants in our sample found (paid) work or other meaningful activities than in observational studies without specific support for social participation. This suggests that focused rehabilitation efforts are beneficial, irrespective of the specific methodology used.

Cardiac rehabilitation goal attainment after myocardial infarction with versus without diabetes: A nationwide registry study

BackgroundPatients with first-time myocardial infarction (MI) and diabetes mellitus (DM) constitute a vulnerable subgroup of cardiovascular (CV) patients for which secondary prevention is particularly important. We investigated if patients with versus without DM differ in attaining four main lifestyle-related cardiac rehabilitation (CR) targets, one-year post-MI. MethodsThis national cohort study (2006–2015) identified individuals with and without DM at hospital admission in the Swedish cardiac registry, SWEDEHEART. CR goal attainment was assessed one year later. The study population included 47,907 unique patients with first-time MI <75 years at baseline (61.8 mean age, 26.7% women, 14.6% with DM). After imputation, propensity score matching was performed. Analyses were conducted with logistic regression. ResultsIn the matched population, having DM was associated (OR [95% CI]) with lower odds of attaining the one-year post-MI CR goal for both smoking cessation (0.90 [0.81, 0.99]) and attendance in exercise training (0.88 [0.83, 0.95]), yet with higher odds of the <1.8 mmol LDL-C target (1.28 [1.19, 1.36]), and similar odds for the <140 mm Hg systolic blood pressure target (0.97 [0.91, 1.04]). In addition, women with DM were particularly unlikely to attend exercise training. ConclusionsPatients with first-time MI and DM are less likely to attain two of four selected CR goals compared to those without DM. The particularly low exercise training attendance by women with DM is of concern. Possibilities for tailored interventions targeting behavioural change for this high-risk group, including focused efforts to increase exercise training attendance in women with DM, should be investigated.

Rehabilitation Services Use and Patient-Reported Outcomes Among Older Adults in the United States

ObjectiveTo characterize rehabilitation service use among community-dwelling older adults in the United States by identifying predictors of rehabilitation utilization, patient-reported functional improvement, and rehabilitation goal attainment. DesignCross-sectional analysis of the 2015 National Health and Aging Trends Study, which used an age-stratified, multistage sampling design and oversampled blacks and the oldest old (≥85y). SettingStandardized, in-person home interviews and physical performance testing. ParticipantsNationally representative sample of community-dwelling Medicare beneficiaries (N=7487) aged ≥65 years. InterventionsNot applicable. Main Outcome MeasuresRehabilitation services use (physical therapy, occupational therapy, and speech therapy) across all settings in the last year, patient-reported functional improvement, and patient-reported rehabilitation goal attainment. ResultsTwenty percent of older adults reported rehabilitation use in the last year. In a multivariable model, rehabilitation use was significantly lower among blacks and higher among those with higher education, chronic medical conditions, pain, history of falls, and severe limitations in physical performance. Overall, 72% reported functional improvement during rehabilitation, and 75% reported meeting their goals by discharge. Improved function was associated with longer duration of rehabilitation. A significantly lower percentage of older adults with bothersome pain and severe physical limitations reported meeting rehabilitation goals. ConclusionsMost older adults who received rehabilitation reported functional improvement and meeting rehabilitation goals. However, social disparities were evident with lower rehabilitation utilization among blacks and those with less education. Importantly, functional improvement and goal attainment did not vary by demographics or diagnoses. Longer duration of rehabilitation and improved pain management may be necessary for functional improvement and goal attainment.

Rehabilitation in the real-life environment of a shopping mall

Aim: The aim of this study was to explore how shopping malls could be used during rehabilitation and to identify the facilitators and barriers to their use.Method: Two focus groups, conducted with 15 rehabilitation professionals from various disciplines and working with people with disabilities of all ages were structured around two topics: (i) The usage of malls for rehabilitation and (ii) Factors that facilitate or limit rehabilitation professionals’ use of the mall as an environment for clinical assessment and/or intervention.Results: The thematic analysis revealed that shopping malls were used to achieve several rehabilitation goals targeting physical and cognitive skills, psychological health and socialization. This real-life environment is motivating and helps foster independence and normalization. Factors affecting mall use during rehabilitation included personal factors (e.g. clients’ personality and level of readiness) and environmental factors (e.g. clinical context, accessibility of the mall and social attitudes of store owners).Conclusion: Shopping malls may be a relevant rehabilitation assessment and treatment environment that could contribute to optimizing community integration of people with disabilities.Implications for rehabilitationTo ensure successful community reintegration, clients could be trained at some point during their rehabilitation, to perform activities in real-life settings, such as a shopping mall.Shopping malls appear to enable the attainment of rehabilitation goals targeting a variety of skills.This real-life environment appears to be motivating and helps foster independence and normalization.Factors felt to affect mall use during rehabilitation include personal factors (e.g. clients’ personality and level of readiness) and environmental factors (e.g. clinical context, accessibility of the mall and social attitudes of store owners).The shopping mall may be an untapped resource as it appears to be a relevant rehabilitation assessment and treatment environment that could contribute to optimizing community integration of people with disabilities.

Quality Improvement Through the Introduction of Interdisciplinary Geriatric Hemodialysis Rehabilitation Care

BackgroundProvision of rehabilitation with the aim of restoring personal independence in elderly hemodialysis patients faces several challenges.DesignQuality improvement report.Setting & ParticipantsFirst 3 years of experience of an inpatient geriatric hemodialysis rehabilitation program in Toronto. Patients with new-onset disability from prolonged illness or an acute event rendering them incapable of living independently.Quality Improvement PlanProvision of in-patient rehabilitation with on-site dialysis; a simplified referral system; preferential admission of elderly dialysis patients; short daily dialysis sessions; integrated multidisciplinary care by experts in rehabilitation, geriatric medicine, and nephrology; and reciprocal continued medical education among staff.MeasuresOutcome measures were percentage of patients discharged home, score on the Functional Independence Measure, and attainment of rehabilitation goals.ResultsIn the first 36 months, 164 dialysis patients aged 74.5 ± 7.8 years were admitted. On admission, patients had a mean Charlson comorbidity score of 7.8 ± 2.5, 98% had difficulty walking, and 84% required help with bed-to-chair transfers. After a median of 48.5 days, 111 patients (69%) were discharged home; 15 patients (9%), to an assisted-living setting; 20 patients (12%), to a long-term care facility; and 18 patients (11%), to other facilities for acute or palliative care. Of those completing therapy, 82% met some or all of their rehabilitation goals.LimitationsThe program relied on the leadership and drive of key personnel. Discharge disposition as an outcome can be affected by many factors, and definition of attainment of rehabilitation goals is arbitrary.ConclusionThe introduction of an integrated dialysis rehabilitation service can help older dialysis patients with new-onset functional decline return to their home. Am J Kidney Dis 00:00-00

The Use of Behavioral and Cognitive Techniques to Facilitate Achievement of Rehabilitation Goals

Noncompliance to rehabilitation programs presents a significant challenge to clinicians. Noncompliant athletes are at greater risk for re-injury and slower return to activity. There is a paucity of information concerning compliance to sports rehabilitation. This paper advocates the use of behavioral and cognitive techniques to facilitate achievement of rehabilitation goals. Behavioral techniques involve the use of specific short-term functional goals to achieve the long-term goal of return to activity. Cognitive techniques involve the relationship between thoughts and action, that is, if athletes are thinking negatively, they are less compliant to rehabilitation programs. Specific examples of both techniques are presented to the clinician that are proposed to increase rehabilitation goal attainment.

Factors Affecting Client Achievement of Rehabilitation Goals

Reliance on vague concepts such as motivation often precludes a deeper diagnostic understanding of client problems in rehabilitation. A more process oriented understanding of behavior emphasizes the multiple factors which influence goal attainment, e.g., the value of the goal, specific and generalized expectancies, environmental barriers, and support from family and friends. Implications of each of these factors for attainment of rehabilitation goals and for the practice of the rehabilitation counselor are discussed.