Person-centered Goals Research Articles

Individualized participatory care planning for individuals with intellectual and developmental disabilities: a qualitative descriptive study

BackgroundGoal setting for persons within health and social care environments can be a challenging task; although health and social care settings aim to address a person’s care needs, the literature tends to focus on health. Person-centred care should encompass the goals/needs/wants of the person, whether these goals focus on career, relationship, and/or health domains. To understand how a person-centred participatory goal setting process is carried out in a care environment, we used an integrated knowledge translation approach.MethodsWe conducted 11 semi-structured interviews with community-care staff to understand a person-centred planning process, including key components and impacts.ResultsThe interviews provide a thorough understanding of an implemented approach to person-centred plans, including its creation, implementation, and benefits (for the person-supported, family, friends, and staff). Person-centred plans provide a map with which to plan activities based on a persons’ goals, interests, and capacities, and have positive impacts for the person-supported, family, friends, and staff.ConclusionsOur study highlights how a community-care organization can facilitate person-centred services through person-centred plans and has implications for wider uptake of person-centred plans in community-care organizations.

Novel Multicomponent Digital Care Assistant and Support Program for People After Stroke or Transient Ischaemic Attack: A Pilot Feasibility Study.

Evidence is increasing for digital health programs targeting the secondary prevention of stroke. We aimed to determine the feasibility of the novel Care Assistant and support Program for people after Stroke (CAPS) or transient ischaemic attack (TIA) by combining person-centred goal setting and risk-factor monitoring through a web-based clinician portal, SMS messages, a mobile application (app), and a wearable device. We conducted a 12-week mixed-methods, open-label feasibility study. Participants (6 months-3 years after stroke or TIA, access to the internet via a smartphone/tablet) were recruited via the Australian Stroke Clinical Registry. Participants set one or two secondary prevention goals with a researcher and provided access and training in technology use. Feasibility outcomes included recruitment, retention, usability, acceptability, and satisfaction. Secondary outcomes included goal attainment, health outcomes, and program costs. Following 600 invitations, 58 responded, 34/36 (94%) eligible participants commenced the program (one withdrawal; 97% retention), and 10 were interviewed. Participants (27% female, 33% TIA) generally rated the usability of the mobile application as 'Good' to 'Excellent' (System Usability Scale). Most (94%) agreed the program helped with engagement in health self-monitoring. Overall, 52 goals were set, predominantly regarding exercise (21/52), which were the most frequently achieved (9/21). At 12 weeks, participants reported significant improvements (p < 0.05) in self-efficacy (Cohen's d = 0.40), cardiovascular health (d = 0.71), and the mental health domain of the PROMIS GH (d = 0.63). CAPS was acceptable, with good retention and engagement of participants. Evaluation of this program in a randomised controlled trial is warranted.

Feasibility and end-user perceptions of a novel digital care assistant and support program for people after stroke or transient ischemic attack (CAPS)

Abstract Background The Care Assistant and support Program for people after Stroke (CAPS) or transient ischaemic attack (TIA) is a clinician-led program designed to improve the secondary prevention of stroke. The program combines person-centred goal setting and risk-factor monitoring through a web-based clinician portal, SMS goal-aligned messages, a mobile application (app), and a wearable device. We aimed to determine the feasibility of CAPS among people living with stroke or TIA, and clinicians who would deliver the program in future. Methods Open label single group pre-posttest mixed-methods evaluation of the 12-week program. Eligible lived-experience participants were recruited through the Australian Stroke Clinical Registry. Eligibility: diagnosis of stroke or TIA in preceding 6 months - 3 years, ≥18 years old, smartphone/tablet ownership, living in the community. Following surveys and interviews of lived-experience participants, ten clinicians experienced in stroke care were invited to participate in focus groups to discuss the program. We used descriptive statistics to evaluate feasibility outcomes, i.e. participant perceptions of usability, acceptability and satisfaction, and clinician perceptions on program design and delivery. Results From 600 invitations, 34 eligible participants commenced the program (27% female, 33% TIA, median 1.7 years from index event; one withdrew). Usability of the CAPS app was rated as ‘Good’ to ‘Excellent’ (System Usability Scale), with moderate sustained usage by study conclusion (&amp;gt;60%). Participants frequently reviewed their health data within the app (average twice a day/participant over 12 weeks), and entered their health measurements an average 73 times/participant. The majority (≥90%) of participants thought the program fitted well into their daily lives or helped engage them in self-monitoring, with 76% indicating they would use the program, if publicly available. Clinician participants included three nurses, three allied health professionals, two neurologists, a stroke consultant, and a general practitioner (GP) in focus groups. Overall, eight had positive perceptions of the CAPS program. Three clinicians indicated the measurements collected in the app captured "vital information", and five saw the value of CAPS to improve secondary prevention. Recommended modifications to the program included tracking atrial fibrillation and blood cholesterol. Seven believed participants would receive the most benefit from the program if delivered within three months post-discharge. Six indicated that GP-led multidisciplinary care was the best model to deliver CAPS. Conclusions The CAPS program was feasible to deliver and acceptable to people living with stroke or TIA. Clinicians saw the value of CAPS for secondary prevention, with feedback prompting further focus groups with GPs to develop the potential model of care. Findings have informed the design of a Phase II randomised feasibility trial.

Lived experiences of children who stutter in their own voices

IntroductionSignificant research has explored the lived experiences of adults who stutter, but less research exists regarding the lived experiences of children who stutter. The opinions and ideas of children who stutter may differ from those of adults, making it important for clinicians and researchers to obtain information directly from children who stutter. Asking children directly can lead to treatment outcomes and research questions that better align with the children's needs and values. Method: Interviews with 18 children who stutter (9 girls/9 boys) ages 8–17 were sourced from the Voices of Children Who Stutter database located at Talkbank.org. Interview questions asked the children about living with a stutter, participating in stuttering support organizations (SSOs), and their perspectives on treatment. Qualitative, phenomenological analysis was performed on their answers following standardized qualitative procedures. Results: Analysis of 910 total utterances yielded 7 themes and 9 subthemes. Themes indicated that the children: (a) had significant knowledge regarding their own stuttering, (b) had opinions regarding what constituted worthwhile treatment outcomes, (c) were clear about desirable clinician characteristics for working with kids who stutter, and (d) saw the benefits of being part of a community. Conclusions: Themes revealed that overall, children who stutter exhibit deep understanding regarding their experiences with stuttering, which clinicians can harness in person-centered goal setting. Additionally, the participants express the importance of participating in stuttering support organizations.

Personalized goals of people living with dementia and family carers: A content analysis of goals set within an individually tailored psychosocial intervention trial.

Person-centered goals capture individual priorities in personal contexts. Goal Attainment Scaling (GAS) has been used in drug trials involving people living with dementia (PLWD) but GAS has been characterized as difficult to incorporate into trials and clinical practice. We used GAS in a trial of New Interventions for Independence in Dementia Study (NIDUS)-family, a manualized care and support intervention, as the primary outcome and to tailor the interventions to goals set. We aimed to assess the feasibility and content of baseline goal-setting. We developed training for nonclinical facilitators to set individualized GAS goals remotely with PLWD and family carer dyads, or carers alone, in the intervention trial, during the COVID-19 pandemic. A qualitative content analysis of the goals set explored participants' priorities and unmet needs, to consider how existing GAS goal domains might be extended in a psychosocial intervention trial context. Eleven facilitators were successfully trained to set and score GAS goals. A total of 313/328 (95%) participants were able to collaboratively set three to five goals with the facilitators. Of these, 302 randomized participating dyads set 1043 (mean 3.5, range 3 to 5) goals. We deductively coded 719 (69%) goals into five existing GAS domains (mood, behavior, self-care, cognition, and instrumental activities of daily living); 324 (31%) goals were inductively coded into four new domains: carer break, carer mood, carer behavior, and carer sleep. The most frequently set goals pertained to social support. There was little variation in types of goals set based on the context of who set them or level of pandemic restrictions in place. It is feasible for people without clinical training to set GAS holistic goals for PLWD and family carers in the community. GAS has potential to facilitate personalization of care and support interventions, such as NIDUS-family, and facilitate the roll out of more personalized care. Goal Attainment Scaling (GAS) can capture meaningful priorities of people with dementia and their family carers.A psychosocial intervention RCT used GAS as the primary outcome measure and goals were set collaboratively by non-clinically trained facilitators.The findings underscore the feasibility of using GAS as an outcome measure with this population.The content analysis findings unveiled the diversity in experiences and priorities of the study participants.GAS has the potential to support the implementation of more person-centred approaches to dementia care.

"Reablement in Flanders: An exploration of the Flemish context.&amp;nbsp;Understanding stakeholders' perspectives."

Background: The primary care sector in Flanders, Belgium, is undergoing an intense period of reform. To incorporate health, well-being and quality of life, care is shifting from acute disease-oriented care to chronic integrated care. There is a need to reform primary care services more directed to community-based service, targeting person-centered care and self-management of people who receive home care and their systems.&#x0D; Reablement is an approach or service model that can be described as a multidisciplinary short term intervention aimed at maintaining and optimizing functional ability and independence of people who receive home care and to promote participation in the local community. The effectiveness of reablement has been researched to a gold standard in different countries worldwide. Results show cost savings, reduced readmission to hospital and to nursing homes as well as increased satisfaction for the professionals and for the people receiving home care. &#x0D; Aim: The purpose of this study is to understand the stakeholder’s perspective on factors that might contribute to a successful and sustainable implementation of reablement in Flanders and factors seen as challenges to deploy this service. By understanding these perspectives, inferences can be made as to whether reablement in Flanders is desirable and feasible.&#x0D; Methods: To perform a context analysis, five focus group interviews were conducted with 35 stakeholders in primary care: patient associations, professional caregivers, health insurance funds, researchers, physiotherapists, occupational therapists, social workers and managers. The focus group interviews were transcribed and an hermeneutical analysis was conducted.&#x0D; Results: The analysis resulted in two main themes: facilitators and challenges for the implementation of reablement in Flanders.&#x0D; Facilitators are: the conviction that multidisciplinary collaboration will be more effective, shared decision making and planning will be encouraged, self management, person centered care, goal oriented and context oriented care will be optimized, continuity of integrated healthcare will be facilitated and the experience of informal caregivers will be better incorporated.&#x0D; Challenges are: lack of a clear definition of reablement in Dutch, people must be intrinsically motivated, the service must be financially and organizationally accessible to all, this approach requires a mindset shift of the healthcare professional, an efficient common communication system is essential and consultation must be financially supported for each person and healthcare professional involved in the service.&#x0D; &#x0D; In general, the goal and the added value of reablement were recognized by everyone as self-evident, but implementation of this service in the current healthcare system in Flanders requires an organizational shift from a supply driven to a demand driven care, a framework for multidisciplinary integrated cooperation and financial support, and sufficient time for both the people who receive home care and the health care professionals. &#x0D; This is the first study involving stakeholders in primary care in Flanders looking at the chances for reablement. Working with primary care providers we now aim to conduct Reable-Labs in different primary care settings in order to provide real life examples and experiences of reablement and its outcomes in the Flemish sector.

SYSTEMATIC REVIEW OF REHABILITATION IN SKILLED NURSING FACILITIES FOR PERSONS LIVING WITH DEMENTIA

Abstract We conducted a systematic review of published literature though April 2023 to identify the experiences and outcomes of persons living with dementia (PLWD) undergoing post-acute care rehabilitation in skilled nursing facilities (SNF). A systematic search for studies published in English was carried out in eight databases including PubMed, Scopus, Google Scholar, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science. Two reviewers independently screened articles and conducted a quality appraisal of selected studies. Forty-one articles met inclusion criteria. There was heterogeneity of study designs with most articles (n=33) being observational and cross-sectional, while randomized clinical trials (n=3) and qualitative studies (n=5) were less represented. Certain themes emerged from the results regarding patient outcomes and experiences. Measured outcomes demonstrated increased health service utilization, varied functional outcomes, and suboptimal patient care. Patient experiences included significant challenges with health care transitions, gaps in healthcare worker and caregiver knowledge &amp; education, emphasis on alternate models of care, and importance of goal alignment. Overall, this systematic review provides a comprehensive understanding of the outcomes and experiences of post-acute care rehabilitation in SNFs for PLWD. The findings highlight the need for alternative care pathways, improved healthcare transitions, tailored rehabilitation approaches, enhanced dementia training for healthcare professionals, and person-centered goal setting. By addressing these critical aspects, future interventions can be developed to improve the delivery of post-acute care for PLWD and enhance their health outcomes.

Experiences of goal planning in Australian community pharmacy settings for people experiencing mental illness: A qualitative study.

Person-centred goal planning is increasingly being incorporated into healthcare interventions. People experiencing severe and persistent mental illnesses (SPMIs) have high levels of co-occurring health conditions, reducing their life expectancy when compared with the general population. As medications are commonly used in the treatment of SPMIs, community pharmacists are well-placed to support the health and wellbeing of this population. To examine pharmacists' and service users' experiences of goal planning as a component of a community pharmacy-based health intervention for people experiencing SPMIs (PharMIbridge intervention). This study utilised a qualitative exploratory approach with an interpretive description method. Semistructured interviews were undertaken with community pharmacists (n = 16) and service user participants (n = 26) who had participated in pharmacist support services for people experiencing SPMIs (PharMIbridge intervention). Four themes relating to goal planning were identified. First, goal planning provided purpose and motivation for participation in the intervention. Planning realistic goals was important but often challenging. Both pharmacists and service users highlighted the relational aspects of goal planning and how strong relationships supported positive behaviour change and outcomes. Finally, individualised and flexible approaches were important aspects of the intervention, ensuring goals were meaningful to service users. The findings from this study identified positive outcomes from the inclusion of goal-planning processes in a community pharmacy-based health intervention. Further research regarding tools, strategies or training that could support future goal-planning interventions in primary healthcare is needed. The PharMIbridge randomised controlled trial research team included lived experience members and was overseen by an expert panel that included members with a lived experience of mental illness and representatives from key organisations. The training provided to pharmacists was co-designed and co-delivered by the researchers and lived experience representatives, and pharmacists were supported by lived experience mentors. Service user participants were invited to participate in the interviews through a number of pathways (e.g., at the completion of the intervention, flyers). Those interested were provided with the full study participant information and provided with a $30 gift voucher at the conclusion of the interview.

Pilot of a person-centred, interdisciplinary approach to goal setting in Ireland’s National Rehabilitation Hospital: a study protocol

Background: Research has emphasized the value of a person-centered, interdisciplinary approach to structured goal setting in rehabilitation; yet these approaches are not consistently implemented in clinical practice, limiting the effect that goal setting can have on rehabilitation. The introduction of a new interdisciplinary, person-centered goal setting process to Ireland’s national rehabilitation hospital offers an opportunity to gain novel insight into barriers to implementing and normalising IDT goal setting in complex, specialist rehabilitation services. Methods: The goal setting process was collaboratively designed based on iterative rounds of patient and staff feedback. It will be piloted in three different units of the hospital. The outlined study was co-designed by embedded academic researchers and knowledge stakeholders (the quality improvement team responsible for introducing the new process; and two former patients). The aim is to use a mixed methods approach to capture patient and staff experiences and perspectives of the new process. Data will be collected by embedded researchers with a combination of self-report measures and qualitative interviews with both staff and patients. Self-report measures focus on capturing person centeredness of goals, shared decision making, interprofessional socialization and process normalization. Quantitative data will be represented using descriptive and inferential statistics; qualitative data will be analysed using reflexive thematic analysis. Discussion &amp; Conclusion: From this data the researchers aim to present a holistic view of the patient and staff experiences of the goal setting process. This may further illuminate challenges and potential solutions to implementing changes to goal setting within this context. Findings will be used to inform implementation within the hospital and will contribute to knowledge for rehabilitation practice around implementing IDT goal setting. This will add an Irish perspective to existing goal setting rehabilitation literature.

Choosing Discourse Types That Align With Person-Centered Goals in Aphasia Rehabilitation: A Clinical Tutorial

Purpose: People with aphasia and their families want rehabilitation services that improve real-world communication. Thus, clinicians and researchers have increased focus on discourse-level interventions and outcome measures, most often using monologue tasks to assess discourse production and guide treatment planning. However, communication in everyday life usually involves participating in conversational discourse. This mismatch raises concern because the literature indicates that different types of discourse possess different linguistic and interactional characteristics and that the communication skills of people with aphasia vary across different types of discourse. In order to provide appropriate, client-centered services, speech-language pathologists (SLPs) need resources that outline the linguistic and interactional characteristics of each type of discourse. Few user-friendly materials of this sort exist. This tutorial aims to equip clinicians with essential foundational knowledge regarding features of narrative, procedural, and expository monologue, as well as conversation, to aid in the design of discourse-level interventions specific to each individual's discourse needs. Method: This tutorial provides an overview of the research regarding the structure and function of commonly assessed and treated forms of discourse, along with findings regarding the varied and unpredictable communicative performance of people with aphasia across the different types of discourse. We then provide practical applied clinical examples to illustrate the literature findings. Conclusion: Given the differences between types of discourse, when SLPs include discourse in a client's treatment program, the types of discourse activities the client wants to address should align very closely with the types of discourse assessed and treated in the clinic room.

Effects of Stroke Rehabilitation Using Gait Robot-Assisted Training and Person-Centered Goal Setting: A Single Blinded Pilot Study

Many stroke survivors have difficulties due to the mobility and activities required in daily living. A walking impairment negatively affects the independent lifestyle of stroke patients, requiring intensive post-stroke rehabilitation. Therefore, the purpose of this study was to examine the effects of stroke rehabilitation using gait robot-assisted training and person-centered goal setting on mobility, the activities of daily living, stroke self-efficacy, and health-related QoL in stroke patients with hemiplegia. An assessor-blinded quasi-experimental study with a pre-posttest nonequivalent control group was used. Participants who were admitted to the hospital with a gait robot-assisted training system were assigned to the experimental group, and those without gait robots were assigned to the control group. Sixty stroke patients with hemiplegia from two hospitals specialized in post-stroke rehabilitation participated. Stroke rehabilitation using gait robot-assisted training and person-centered goal setting for stroke patients with hemiplegia was conducted for a total of six weeks. There were significant differences between the experimental group and control group in the Functional Ambulation Category (t = 2.89, p = 0.005), balance (t = 3.73, p < 0.001), Timed Up and Go (t = -2.27, p = 0.027), Korean Modified Barthel Index (t = 2.58, p = 0.012), 10 m Walking test (t = -2.27, p = 0.040), stroke self-efficacy (t = 2.23, p = 0.030), and health-related quality of life (t = 4.90, p < 0.001). A gait robot-assisted rehabilitation using goal setting for stroke patients with hemiplegia improved gait ability, balance ability, stroke self-efficacy, and health-related quality of life in stroke patients.

Power triggers moral reasoning aligned with active goals and moral flexibility across contexts.

Three experiments tested the hypothesis that power elicits moral judgments in line with active goals, and moral flexibility across different contexts. Power and goals emanating from the mission associated with power were experimentally manipulated: person-centered mission, which benefits from outcome-focus, or regulation-centered mission, which benefits from rule-based focus. Power consistently elicited rule-based (deontological) moral reasoning under regulation-centered goals. However, power triggered outcome-based (utilitarian) moral reasoning under person-centered goals. Power enhanced goal serving morality due to greater goal commitment, with focal goal commitment mediating the interactive effects of power and focal goal on moral judgments. These findings show that the links between power and morality are context sensitive, flexible, and mediated by a greater commitment to active goals.

The Functional External Memory Aid Tool Version 2.0: A How-To Clinical Guide.

Although compensatory cognitive rehabilitation is a common treatment approach for adults with cognitive-communication disorders, there are few assessment tools available to support clinicians in developing person-centered treatment plans. In addition to understanding a client's cognitive and functional abilities, it is also important to understand how they compensate for their weaknesses, specifically with external aids (e.g., calendars, notes), in everyday life. The Functional External Memory Aid Tool (FEMAT) is a performance-based measure that quantifies and describes external aid use during task completion. The purpose of this clinical focus article is to educate and equip clinicians to administer and interpretate the FEMAT with adult clients with cognitive-communication disorders. This clinical focus article describes the theoretical motivation for the FEMAT as well as the administration, scoring, and interpretation procedures for Version 2.0 of the measure. A hypothetical case example is included to illustrate how to use the FEMAT to develop person-centered goals and treatment plans. The FEMAT is psychometrically sound, clinically relevant, free, easily accessible, and quick to administer and provides data that are complementary to data obtained from traditional performance-based and/or patient-reported measures. This clinical focus article describes new resources that are available to help clinicians administer and interpret Version 2.0 of the FEMAT when serving adults with cognitive-communication disorders. https://doi.org/10.23641/asha.21651311.

Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke

Develop and test a person-centred goal-setting package for discharge care planning in acute and rehabilitation stroke units. A multidisciplinary, expert working group (n = 15), and consumer group (n = 4) was convened. A multistage iterative approach was used to develop and test the package. Stages included: (i) contextual understanding, (ii) package development, and (iii) clinician training and field-testing in acute and rehabilitation settings. Observational field notes were taken and clinicians' perspectives captured using semi-structured focus groups post-testing. The final package included a 34-item menu aligned with a manual containing: guideline summaries; common goals; goal metrics based on the SMART Goal Evaluation Method (SMART-GEM); evidence-based strategies; and worked examples. Twenty-three clinicians attended training. Clinician observations (n = 5) indicated that: the package could be incorporated into practice; a range of person-centred goals were set; and opportunities provided to raise additional issues. Clinician feedback (n = 8) suggested the package was useful and facilitated person-centred goal-setting. Enablers included potential for incorporation into existing processes and beliefs that it promoted person-centred care. Barriers included additional time. The package demonstrated potential to facilitate comprehensive person-centred goal-setting for patients with stroke. We developed an innovative approach to support structured person-centred goal setting in clinical and research settings.

A mixed-methods feasibility study of a new digital health support package for people after stroke: the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention

BackgroundEvidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial.MethodsWe conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions.ResultsBetween November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals.ConclusionThe study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-7237

Use of person-centered goals to direct interdisciplinary care for military service members and Veterans with chronic mTBI and co-occurring psychological conditions.

To explore the use of person-centered goals (PCGs) to direct interdisciplinary care to support PCG attainment in military service members and Veterans (SM/Vs) with chronic mild traumatic brain injury (mTBI) and co-occurring psychological conditions. A retrospective chart review was completed for 146 United States military SM/Vs reporting chronic symptoms following mTBI and co-occurring psychological conditions who received care in the SHARE Military Initiative intensive outpatient program, a donor-funded program administered by a not-for-profit hospital, between April 1, 2015 and March 31, 2019. PCGs were used to direct care consisting of individual and group-based interventions and therapies delivered by an interdisciplinary, co-located team including behavioral health, case management, neurology or physiatry, nursing, occupational therapy, physical therapy, recreation therapy, speech-language pathology, and transition support. The primary outcome measure was PCG attainment measured via goal attainment scaling. Increased PCG attainment was demonstrated at program discharge and throughout the first year following program discharge. Predictors of goal attainment at discharge included longer participation in treatment, greater reduction in depressive symptoms and greater improvement in adjustment at discharge, male gender, and higher cognitive and physical abilities on admission. This sample of military SM/Vs with mTBI and co-occurring psychological conditions who received intensive, interdisciplinary, PCG directed care demonstrated increased PCG attainment at program discharge which further increased with transition support over the year post-discharge. Results suggest PGC goal directed care is a feasible, promising methodology of individualizing treatment in this population. This exploratory study lays a foundation for future prospective, controlled, comparative effectiveness research that will further understanding of the effectiveness of intensive, interdisciplinary, PCG directed care.

Communicative participation in goal-setting meetings for patients with aphasia after stroke. A study using patients' and healthcare professionals' self-ratings.

Communicative participation poses a challenge in meetings between healthcare professionals (HCPs) and people with aphasia (PwA). How communication is affected by aphasia in group meetings, where several healthcare professionals participate together with the patient, is largely unexplored. The aim of this study was to investigate self-rated communicative participation during goal-setting meetings among PwA compared to patients without aphasia and to investigate whether communicative participation among PwA was associated with self-rated knowledge about aphasia among HCPs. A further aim was to investigate if there was a difference in the use of communication strategies among HCPs in the respective situations. Nine PwA and nine control patients without aphasia rated their experience of communication during a goal-setting meeting. Thirty-eight HCPs rated their knowledge about aphasia and communication, and their use of communication strategies during goal-setting meetings. The PwA reported being listened to by the HCPs as well as being able to comprehend the meeting. PwA with more severe language impairment did not report a lower level of communicative participation compared to PwA with milder impairment. Half of the patients from both groups indicated some difficulty asking questions during the meeting. Patients' ratings of communication were not correlated to HCPs' knowledge of communication strategies. There was a significant difference in self-rated use of communication strategies among HCPs for the two conditions, although the individual variation was large. Results from both PwA and controls imply that patients may need more support to be able to ask questions in meetings with HCPs. Although self-ratings increase the ecological validity of the study of participation, further studies could benefit from using video observations in combination with self-reported experience, since awareness might influence results. What is already known on this subject Aphasia is an acquired language disorder that affects patient-provider communication. In stroke rehabilitation, person-centred goal setting is a key component. If healthcare professionals (HCPs) are not able to use adequate communication strategies, a lack of accessible communication can become a barrier to person-centredness. There are evidence-based communication strategies which can be used to overcome this barrier. What this paper adds to existing knowledge This study aimed to investigate communicative participation during goal-setting meetings from the perspective of patients with aphasia and HCPs. To our knowledge, this is the first study where persons with aphasia are asked to rate communicative participation in goal-setting meetings. To broaden the perspective on communication and goal setting, ratings of patients with aphasia are compared to ratings by patients with stroke but no aphasia. The results of this study indicate that there is room for improvement regarding communication during goal-setting meetings. However, asking direct questions on communicative participation to persons with severe aphasia may not be feasible. What are the potential or actual clinical implications of this work? The results of this study imply that both patients with and without aphasia may need more support to be able to express themselves during goal-setting meetings. There also seems to be a need for further education on aphasia and communication strategies among rehabilitation professionals.

Implementation of a Mobile Technology-Supported Diaphragmatic Breathing Intervention in Military mTBI With PTSD.

Diaphragmatic breathing is an evidence-based intervention for managing stress and anxiety; however, some military veterans with mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) report challenges to learning and practicing the technique. BreatheWell Wear assists performance of breathing exercises through reminders, biofeedback, and visual, tactile, and auditory guidance. To evaluate feasibility of implementing BreatheWell Wear, a mobile smartwatch application with companion smartphone app, as an intervention for stress management in military veterans with mTBI and PTSD. Thirty veterans with chronic symptoms of mTBI and PTSD recruited from an interdisciplinary, intensive outpatient program participated in this pilot pragmatic clinical trial. Participants were randomly assigned to the experimental (BreatheWell Wear and conventional care) and control (conventional care) groups for 4 weeks. Conventional care included instruction on relaxation breathing and participation in behavioral health therapy. Effects on goal attainment, treatment adherence, diaphragmatic breathing technique knowledge, and stress were measured through surveys and diaries. Changes in symptoms, mood, and well-being were measured pre/postintervention via the Posttraumatic Checklist for DSM-5, Beck Anxiety Inventory, Beck Depression Inventory, and Flourishing Scale. Person-centered goal attainment (t = 4.009, P < .001), treatment adherence (t = 2.742, P = .001), diaphragmatic breathing technique knowledge (t = 1.637, P < .001), and reported ease of remembering to practice (t = -3.075, P = .005) were significantly greater in the experimental group. As expected, measures of PTSD, anxiety, depression, and psychological well-being showed clinically meaningful change in both groups, and both groups demonstrated reduced stress following diaphragmatic breathing. These preliminary findings indicate that BreatheWell Wear may be a clinically feasible tool for supporting diaphragmatic breathing as an intervention in veterans with mTBI and PTSD, and a future effectiveness trial is warranted.

Goals and Action Plans Across Time and Place-A Qualitative Study Exploring the Importance of "Context" in Person-Centered Rehabilitation.

BackgroundPerson-centeredness is increasingly addressed in relation to rehabilitation interventions. Collaborative goal setting and action plans are key measures in person-centered rehabilitation. There is a lack of knowledge about how person-centered goals and action plans developed away from the patient's everyday life are experienced by patients after discharge.PurposeThis aim of the study is to explore how patients with rheumatic diseases experience the relevance of goals and action plans after discharge from inpatient rehabilitation hospital stay.MethodsIndividual narrative interviews were conducted with eight patients with rheumatic diseases, aged between 40 and 60. A convenience sampling strategy was applied. Data collection, analysis and interpretation of data were performed within a phenomenological-hermeneutic framework inspired by Paul Ricoeur's interpretative philosophy.ResultsThe analysis derived one core theme, “The relevance of goals and action plans is contextual” and three subthemes: “Admission—a protected bubble,” “Back home—a harsh reality,” and “Need for post-discharge support.”ConclusionThis study indicates that the relevance of goals and action plans to patients with rheumatic diseases is context specific. On the basis of the study, it is suggested that the context should be considered in rehabilitation practice, including the social network of the patients. This is in order to support patients in rehabilitation interventions to manage everyday life with disease after discharge to their own homes. Moreover, the concept of context in person-centered rehabilitation should be reconsidered. The study also concludes that there is a need for further development and research in follow up programs, as it is not clear what may constitute an optimal design of follow up support.

Normalising interdisciplinary role-based goal setting in inpatient brain injury rehabilitation: reflections and recommendations of clinicians

Purpose Person-centred goal setting with people with brain injury, by interdisciplinary teams has benefits including improved communication between patients, families and clinicians, person-centred care, and improved engagement in rehabilitation. Exploring the experiences of team members who have adopted interdisciplinary, person-centred goal setting may assist in understanding what is needed to implement this complex, core component of rehabilitation practice. This study explored experiences of clinicians working in an extended inpatient brain injury rehabilitation unit about implementing a role-based goal planning approach within an interdisciplinary team. Materials and methods Semi-structured interviews with 13 clinicians working at the rehabilitation unit explored their experiences about the cognitive participation and collective actions required to carry out the practice, with data analysed using inductive content analysis guided by Normalisation Process Theory. Results Three primary themes were identified: putting the person at the centre, accepting the mind-shift to participation focused goals and working collaboratively. Conclusions This study has elucidated some key processes that occurred and were necessary to carry out goal setting. A mind-shift towards holistic, participation-focussed goal setting was described as “unlearning” discipline-specific goal setting. Development and ownership by the team, acceptance of team members and willingness to share, and structured processes and resources were necessary. IMPLICATIONS FOR REHABILITATION Normalising interdisciplinary role-based goal setting in multi-professional teams requires a mind-shift away from traditional, discipline-specific goal setting. Implementation of interdisciplinary, collaborative team goal setting within health service settings requires collective actions including collaborative working by team members, structured processes including organised time for collaborative team and family meetings, practical resources and training to support processes. Clinicians perceived the goal setting approach to put the person at the centre resulting in a deep understanding of the person, shared understanding, and motivation for rehabilitation.