Goal Setting In Rehabilitation Research Articles

A single-case experimental design investigation of collaborative goal setting practices in hospital-based speech-language pathologists when provided supports to use motivational interviewing and goal attainment scaling

ABSTRACT The study investigated the impact of the electronic Goal Attainment Scaling (eGAS) process on medical speech-language pathologists’ (SLPs) interviewing and goal setting. The process was trained via the eGAS app, designed to facilitate motivational interviewing and goal attainment scaling. The study utilized a single-case, nonconcurrent, multiple-baseline design replicated across three clinicians and their 27 respective clients. We observed client-clinician dyads engaged in setting rehabilitation goals pre and post eGAS training. The clients had neurogenic conditions and were being treated for cognitive, communication and/or swallowing challenges in an outpatient setting. Two measures were used to collect data on the clinician’s interviewing and goal-setting behaviors: (1) Assessment of Client-Centeredness when Interviewing and Goal Setting (ACIG) scale, and (2) a task analysis, i.e., the Clinician Interview Behavior scale (CIB). Training with eGAS had a strong effect on clinicians’ collaborative interviewing behaviors, an inconsistent effect on their ability to adhere to a three-phase interview structure, and a strong effect on their ability to generate valid goal attainment scales. This study provides preliminary support that the eGAS process provides a feasible framework for training hospital-based SLPs engaged in neurorehabilitation to use collaborative interviewing behaviors and produce valid person-centered rehabilitation goals.

Use of technology in supporting goal setting in rehabilitation for adults: a scoping review

ObjectiveTo map the extant literature evaluating the use of technology for goal setting in adult rehabilitation and the impact of technology for patient outcomes.DesignScoping review.MethodsMEDLINE (via Ovid), CINAHL (via EBSCO),...

Facilitators and \u201cdeal breakers\u201d: a mixed methods study investigating implementation of the Goal setting and action planning (G-AP) framework in community rehabilitation teams

BackgroundHigh quality goal setting in stroke rehabilitation is vital, but challenging to deliver. The G-AP framework (including staff training and a stroke survivor held G-AP record) guides patient centred goal setting with stroke survivors in community rehabilitation teams. We found G-AP was acceptable, feasible to deliver and clinically useful in one team. The aim of this study was to conduct a mixed methods investigation of G-AP implementation in diverse community teams prior to a large-scale evaluation.MethodsWe approached Scottish community rehabilitation teams to take part. Following training, G-AP was delivered to stroke survivors within participating teams for 6 months. We investigated staff experiences of G-AP training and its implementation using focus groups and a training questionnaire. We investigated fidelity of G-AP delivery through case note review. Focus group data were analysed using a Framework approach; identified themes were mapped into Normalisation Process Theory constructs. Questionnaire and case note data were analysed descriptively.ResultsWe recruited three teams comprising 55 rehabilitation staff. Almost all staff (93%, 51/55) participated in G-AP training; of those, 80% (n = 41/51) completed the training questionnaire. Training was rated as ‘good’ or ‘very good’ by almost all staff (92%, n = 37/41). G-AP was broadly implemented as intended in two teams. Implementation facilitators included - G-AP ‘made sense’; repetitive use of G-AP in practice; flexible G-AP delivery and positive staff appraisals of G-AP impact. G-AP failed to gain traction in the third team. Implementation barriers included - delays between G-AP training and implementation; limited leadership engagement; a poor ‘fit’ between G-AP and the team organisational structure and simultaneous delivery of other goal setting methods. Staff recommended (i) development of training to include implementation planning; (ii) ongoing local implementation review and tailoring, and (iii) development of electronic and aphasia friendly G-AP records.ConclusionsThe interaction between G-AP and the practice setting is critical to implementation success or failure. Whilst facilitators support implementation success, barriers can collectively act as implementation “deal breakers”. Local G-AP implementation efforts should be planned, monitored and tailored. These insights can inform implementation of other complex interventions in community rehabilitation settings.

Measuring shared decision-making and collaborative goal setting in community rehabilitation: a focused ethnography using cross-sectional surveys in Canada

ObjectiveTo describe and measure the shared decision-making (SDM) experience, including goal-setting experiences, from the perspective of patients and providers in diverse community-rehabilitation settings.DesignProspective, longitudinal surveys.Setting13 primary level-of-care community-rehabilitation sites in...

Effects of Behavioral Weight Loss and Weight Loss Goal Setting in Cardiac Rehabilitation.

Obesity is prevalent among participants in cardiac rehabilitation (CR). Establishing a weight loss goal is an important strategy for promoting weight loss. We evaluate the association between a pre-program weight loss goal and change in weight during CR. Body weight was measured at CR entry and at exit from CR. Overweight/obese participants were categorized as having: (1) established a weight loss goal and attended behavioral weight loss sessions (G + BWL); (2) set a weight loss goal but did not attend BWL (G); (3) and neither set a weight loss goal nor attended BWL (NoG). The cohort consisted of 317 overweight/obese participants; 52 of whom set a weight loss goal and attended BWL, 227 patients set a goal but did not attend BWL, and 38 did neither. The G + BWL group lost more weight than the G group (-6.8 + 4.3 vs -1.1 + 3.5) (P < .0001). Both groups that established a weight loss goal lost more weight than the NoG group. For overweight/obese individuals in CR, participating in BWL classes and setting a weight loss goal leads to more weight loss than G alone. Setting a weight loss goal alone leads to greater weight loss than not setting a weight loss goal.

Child, parent, and clinician experiences with a child-driven goal setting approach in paediatric rehabilitation

Purpose To explore child, parent, and clinician experiences with a child-driven approach to rehabilitation goal setting. Methods Nine children receiving inpatient and outpatient rehabilitation aged 5.0–12.3 years ( = 8.3, SD = 2.3; 5 females) and their parents (n = 9) participated in a goal setting process intended to maximize child engagement with their physical or occupational therapist. Qualitative interviews were conducted with children (n = 7), their parents (n = 9), occupational therapists (n = 2), a nurse practitioner and a physician to explore their experience with the child-driven approach to goal setting. Results Three themes that reflect child, parent, and clinician experience with a child-driven approach to goal setting were identified: (1) children have voice and insight, (2) child identified goals are rewarding and motivating for children, and (3) we are a team: goal setting as a co-constructed process. Conclusions Engagement in goal setting resulted in the identification of functional goals that were perceived as motivating for children. Children described feeling valued and heard. Parents and clinicians recognized they had previously underestimated the capacity of children to identify their own goals. Parents wanted input from therapists, particularly related to shaping their goals to focus on shorter-term outcomes. Relational autonomy, which emphasizes the social and relational aspects of decision-making, may be more useful than traditional, individualistic views of autonomy for conceptualizing clinician roles in collaborative goal setting. IMPLICATIONS FOR REHABILITATION Children are often not optimally involved in setting their own rehabilitation goals. In this qualitative study, we report that children, parents, and clinicians recognized the value of optimizing child engagement in goal setting including children feeling heard, valued and more motivated to participate in therapy. Parents expressed a need for a collaborative approach to goal setting that respects child, parent, and clinician input. Relational autonomy may be a useful framework for reframing the role of clinicians in collaborative goal setting processes.

Experiences with and perspectives on goal setting in spinal cord injury rehabilitation: a systematic review of qualitative studies.

Systematic review of qualitative studies. To synthesise qualitative research exploring the experiences and perspectives of persons with spinal cord injury (SCI), relatives and health professionals concerning goal setting in SCI rehabilitation. Five electronic databases were searched. A search strategy was constructed with key concepts identified using PICo (Population, phenomena of Interest and Context). Peer reviewed studies complying with the inclusion criteria were selected. Interpretive Description methodology guided analysis and synthesis of the findings. The search yielded 427 records. Of 12 full text studies assessed for eligibility, four were included describing goal setting in SCI rehabilitation from the perspective of persons with SCI and health professionals. Persons with SCI described a need for goal setting to be related to their everyday life, whereas the health professionals tended to use the hospital setting as their point of reference. Persons with SCI emphasised the importance of being self-directed and taking an active role in goal setting and rehabilitation. No studies presented the perspective of relatives. This review illuminates the divergence in the understanding of goal setting between persons with SCI and health professionals. Goal setting in SCI rehabilitation often directly reflects physical functioning goals set by the health professionals, which does not prepare persons with SCI for everyday life and emotional issues. There is lack of focus on goals addressing psychosocial components such as family issues and change of roles. A shared process with goal setting relevant to persons with SCI and their everyday life is needed.

Development of a comprehensive core set from the international classification of functioning, disability and health for return to work among patients with stroke through Delphi-based consensus.

Young patients with stroke are typically the economic support of their families and societies, and their return to work (RTW) is crucial to maintaining their quality of life. However, the identification of RTW-related factors of different aspects is complicated and a systematic analysis of these factors is lacking. The aim of this study was to develop a core set from the International Classification of Functioning, Disability and Health (ICF) for return to work (RTW) among patients with stroke. Three-round Delphi-based consensus. University-based hospital. Thirty experts in stroke-related domains from different institutions. A five-point Likert Scale was used to rate the importance of each item. Consensus of ratings was analyzed using Spearman's rho and semi-interquartile range indices. The International Classification of Functioning, Disability and Health core set for return to work among patients with stroke was based on a high level of consensus and a mean score of ≥4.0 in the third round of the Delphi. The ICF core set comprised 58 categories distributed as follows: 16 body function, 30 activities and participation, 10 environmental factor, and 2 personal factors. Our ICF core set for RTW among patients with stroke can inform effective rehabilitation strategies and goal setting for RTW among patients with stroke. However, further validation is warranted. ICF core set could provide information on rehabilitation strategies setting for RTW of stroke patients.

KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease.

Clinical consensus statements (CCSs) aim to improve care for patients with Parkinson's disease (PD) and reduce the variability of rehabilitation methods in clinical practice. A literature search was conducted to find available evidence on the rehabilitation of patients with PD and to determine the scope of CCSs. The selection of PD rehabilitation domains and key questions was done using the modified Delphi method in 43 expert panels. These panels achieved a consensus on 11 key questions regarding rehabilitation assessment and goal setting, gait and balance, activities of daily living, and swallowing and communication disorders. After the completion of an agreement procedure, 11 key consensus statements were developed by the consensus panel. These statements addressed the needs of rehabilitation as a continuum in patients with PD. They included the appropriate rehabilitation initiation time, assessment items, rehabilitation contents, and complication management. This agreement can be used by physiatrists, rehabilitation therapists, and other practitioners who take care of patients with PD. The consensus panel also highlighted areas where a consensus could not be reached. The development of more focused CCS or clinical practice guidelines that target specific rehabilitation approaches is considered the next needed step.

ICF-inspired goal-setting in developmental rehabilitation: an innovative framework for pediatric therapists

ABSTRACT Background: Collaborative goal-setting is a fundamental component of developmental physical and occupational therapy practice. Evidence suggests, however, that therapists struggle to elicit patient and family goals, and they often establish goals that are not reflective of patient and caregiver functional preferences. Training and efficiency also act as barriers to collaborative goal-setting. A number of solutions have been proposed to enhance the goal-setting process, but none specifically address relevant areas of functioning within the International Classification of Functioning, Disability and Health (ICF), a robust, multidimensional tool that emphasizes the importance of function. To support pediatric therapists in the collaborative establishment of functionally relevant goals, an ICF-inspired goal-setting tool was developed through the assimilation of a large body of existing scientific evidence, ICF Core Sets, and expert consensus. Objective: The aims of this paper are to: 1) describe an ICF-inspired framework for collaborative goal-setting in developmental rehabilitation that seeks to reduce the methodological challenges frequently associated with goal-setting; and 2) discuss the conditions for the use of the framework in daily therapeutic practice. Conclusions: The goal-setting framework presented in this paper may help pediatric therapists to create meaningful goals in collaboration with patients and families. Importantly, the goal-setting framework described promotes the use of the ICF in therapeutic practice.

Walking velocity and modified rivermead mobility index as discriminatory measures for functional ambulation classification of chronic stroke patients

Background:The cut-off values of walking velocity and classification of functional mobility both have a role in clinical settings for assessing the walking function of stroke patients and setting rehabilitation goals and treatment plans.Objective:The present study investigated whether the cut-off values of the modified Rivermead Mobility Index (mRMI) and walking velocity accurately differentiated the walking ability of stroke patients according to the modified Functional Ambulation Category (mFAC).Methods:Eighty two chronic stroke patients were included in the study. The comfortable/maximum walking velocities and mRMI were used to measure the mobility outcomes of these patients. To compare the walking velocities and mRMI scores for each mFAC point, one-way analysis of variance and the post-hoc test using Scheffe’s method were performed. The patients were categorized according to gait ability into either or mFAC VI group. The cut-off values for mRMI and walking velocities were calculated using a receiver-operating characteristic curve. The odds ratios of logistic regression analysis (Wald Forward) were analyzed to examine whether the cut-off values of walking velocity and mRMI can be utilized to differentiate functional walking levels.Results:Except for mFACs III and IV, maximum walking velocity differed between mFAC IV and mFAC V , between mFAC V and mFAC VI , and between mFAC VI and mFAC VII . The cut-off value of mRMI is and the area under the curve is 0.87, respectively; the cut-off value for comfortable walking velocity is m/s and the area under the curve is 0.92, respectively; also, the cut-off value for maximum walking velocity is m/s and the area under the curve is 0.97, respectively. In the logistic regression analysis, the maximum walking velocity m/s, and mRMI scores, are able to distinguish from mFAC VI.Conclusion:The cut-off values of maximum walking velocity and mRMI are recommended as useful outcome measures for assessing ambulation levels in chronic stroke patients during rehabilitation.

What Matters to you, Matters to me: Promoting Patient Centered Care in Rehabilitation

To increase patient centered care in inpatient rehabilitation goal setting; to increase the frequency with which patient centered goals for rehabilitation were addressed in the inpatient rehabilitation setting.

Evaluation of Effectiveness of Child-oriented Goal-setting in Paediatric Rehabilitation (the ENGAGE Approach)

Evaluation of Effectiveness of Child-oriented Goal-setting in Paediatric Rehabilitation (the ENGAGE Approach)

Setting meaningful goals in rehabilitation: rationale and practical tool

Context: Goal-setting is a key characteristic of modern rehabilitation. However, goals need to be meaningful and of importance to the client. Axioms: Both theories and empirical evidence support the importance of a hierarchy of goals: one or more overall goals that clients find personally meaningful and specific goals that are related to the overall goals. We posit that the client’s fundamental beliefs, goals and attitudes (“global meaning”) need to be explored before setting any rehabilitation goal. A chaplain or other person with similar skills can be involved in doing so in an open-ended way. The client’s fundamental beliefs, goals and attitudes serve as a point of departure for setting rehabilitation goals. Setting goals: We set out a three-stage process to set goals: (1) exploring the client’s global meaning (i.e. fundamental beliefs, goals and attitudes), (2) deriving a meaningful overall rehabilitation goal from the client’s global meaning and (3) setting specific rehabilitation goals that serve to achieve the meaningful overall rehabilitation goal. Conclusion: This is an extension of current practice in many rehabilitation teams, which may help counter the drive toward exclusively functional goals based around independence.

Stroke Survivors' Perspectives on Post-Acute Rehabilitation Options, Goals, Satisfaction, and Transition to Home.

Patients and caregivers have not typically been involved in the selection of a post-acute care (PAC) provider. In 2015, the Centers for Medicare & Medicaid Services proposed the need to involve patients and their families during discharge planning. Engaging patients in rehabilitation decisions encourages shared decision making among patients and their clinicians. The purpose of this study was to examine stroke survivors' perspectives on their involvement in selecting a PAC provider and their goal setting and their satisfaction with the rehabilitation stay and their discharge advice for stroke survivors, prior to 2015. This qualitative study utilized semistructured interviews. Thematic content analysis was performed on interviews involving 18 stroke survivors (mean age = 68 years) related to their involvement in planning for their inpatient rehabilitation facility or skilled nursing facility stay, goal setting, and discharge needs. More than half the participants were not involved in the selection of their PAC setting and believed that doctors made these decisions. Around two-fifths of stroke survivors reported that they were not involved in rehabilitation goal setting. Most patients were satisfied with their rehabilitation stay. When asked to recommend discharge topics for other stroke survivors, participants recommended additional information on health care services, interventions, and insurance coverage. Despite recommendations to include stroke patients in PAC selection and goal setting, many former inpatient rehabilitation facility and skilled nursing facility patients report not being involved in either aspect of care.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A273).

Goal statements in brain injury rehabilitation: A cohort study of client-centredness and relationship with goal outcome

AbstractBackground:Currently, there is increasing recognition of the need to use a client-centred approach to goal setting in rehabilitation. However, there is limited research to guide practice with community-dwelling clients with acquired brain injury. An understanding of the characteristics of client-centred goals and the extent to which client-centeredness influences goal outcomes is required.Objective:To examine the relationships between the client-centredness of goals and their characteristics, content, recall and outcomes of client-centred goals in brain injury rehabilitation.Methods:A prospective cohort design study was employed. Participants were 45 clients with brain injury receiving outpatient rehabilitation, who completed measures of client-centredness after goal setting. Each goal was classified according to whether it was specific, measurable, non-jargonistic, and participation-focussed, included a timeframe and was recalled by participants.Results:Participants set 223 goals with 20 clinicians from multiple disciplines. Levels of client-centredness did not differ according to the characteristics, content and recall of goals, with the exception of goal specificity (p&lt; 0.01). Client-centredness was significantly and positively correlated with goal outcomes (p&lt; 0.05).Conclusions:The use of client-centred goals is recommended for improved rehabilitation outcomes. Applying goal documentation criteria does not necessarily mean that goals will be client-centred, and highly specific goal statements may not reflect what is important and meaningful to clients.

A review of goal setting theories relevant to goal setting in paediatric rehabilitation

Background: Goal setting in paediatric rehabilitation is influenced by shifting parent, sibling, caregiver, and child roles over time and evolving child developmental capacity for participation in the process. A theoretical and evidence-informed approach to goal setting, specific to paediatrics, would provide a framework for goal setting in practice and facilitate systematic evaluation of the effects of goal-setting processes on child and family outcomes. Objective: To provide an overview of relevant goal-setting theories and their implications for paediatric rehabilitation. Methods: Prevalent theories were identified from relevant rehabilitation, motivation, behaviour change, and goal-setting literature. Implications for goal setting in paediatrics are summarized according to goal-setting and action-planning phases: (1) preparation, (2) formulation of goals, (3) formulation of action plan, (4) coping planning, and (5) follow up. Results: Social cognitive theory, self-determination theory, Health Action Process Approach, Mastery Motivation, and goal-setting theory are reviewed. Examples of implications for goal setting include, sharing information with families about the purpose of goal setting; identifying goals that are specific, proximal, challenging, and important to the child; and addressing self-efficacy. Conclusion: The theories reviewed have clear implications for paediatric rehabilitation research and practice. They address considerations not typically discussed in adult rehabilitation such as observing children to obtain information about meaningful goals when they are unable to communicate them directly and the importance of establishing flexible processes that will accommodate changing family roles over time. Research is needed to evaluate the effects of goal-setting processes and strategies on outcomes in paediatric rehabilitation.

Development and Validation of the Occupational Self-Assessment-Short Form (OSA-SF).

The Occupational Self-Assessment, Version 2.2 (OSA 2.2), is a client-centered measure of clients' perceived occupational competence and value. The OSA 2.2 has previously demonstrated good structural validity and internal consistency; however, the administration length could deter therapists from using this assessment in acute care and acute inpatient rehabilitation. To evaluate reliability and validity of the OSA 2.2 in acute care and acute inpatient rehabilitation and to develop and validate the OSA-Short Form (OSA-SF). We performed a descriptive psychometric analysis using the Rasch analytic approach. The data were collected in acute care and acute inpatient rehabilitation. Our convenience sample consisted of 86 patients in acute care and acute inpatient rehabilitation. Participants rated their perceived occupational competence and value by completing the OSA 2.2. We examined psychometric properties of the OSA 2.2 and OSA-SF using a partial credit Rasch model. The 21-item OSA 2.2 was reduced to a 12-item OSA-SF through iterative removal of items on the basis of item-misfit statistics. The OSA-SF demonstrated adequate rating scale functioning, dimensionality, item and person goodness of fit, item targeting, item hierarchies, and item and person separation. Findings indicate that the OSA-SF is a valid and reliable measure that can guide client-centered goal setting and intervention planning for adults receiving acute care and acute inpatient rehabilitation. The OSA 2.2 and the OSA-SF offer a client-centered approach to evaluating patients' self-reported ability and ratings of the importance of performing everyday occupations. These assessments can guide client-centered goal setting in acute care and acute inpatient rehabilitation.

Effectiveness of individualized, goal directed institutional based rehabilitation programme in children with developmental delay disorders, in a region with limited rehabilitation accessibility.

To evaluate effectiveness of individualized, goal directed rehabilitation protocol in improving functional outcomes in children with developmental delay disorders in a region with limited rehabilitation accessibility and to explore if goal setting influences changes observed in functional levels. Children (6 months to 17 years) with developmental delay, who visited as out-patients to the Department of Physical Medicine and Rehabilitation and whose care givers were willing to participate in the study, were enrolled for a period of one year. Individualized rehabilitation protocol targeting the child's specific problems with a simultaneous home programme was performed. A single group pre-post study design was used to assess the protocol's effectiveness. Goal attainment scale (GAS), Gross Motor Function Classification System (GMFCS) Level, Gross Motor Functional Measure (GMFM) and Manual Ability Classification System (MACS) were administered pre and post-intervention monthly for 3 months. Statistical analysis was done using SPSS statistics version-22. Total of 32 children participated in the study. Significant differences between pre and post scores of GAS score (Wilcoxon's signed rank test [W value] = 4.937, p-value < 0.005), GMFCS (W value: -3.435, p-value < 0.005), GMFM (W value: 4.937, p-value < 0.005) and MAC score (W value: -4.714, p-value < 0.005) were noted at 3 months. No correlation was observed between the GAS pre-post score and GMFM, GMFCS and MAC pre-post scores. An effective rehabilitation programme in children with developmental delay should be individualized and should be goal directed to achieve maximum functional improvement. Improvement in the goals set were independent of the improvement in functional outcome levels. Care-givers play a pivotal role in both individualization and goal setting for rehabilitation, especially in a region with limited rehabilitation accessibility.

Narrative storytelling as both an advocacy tool and a therapeutic process: Perspectives of adult storytellers with acquired brain injury

ABSTRACT As part of a larger study exploring narrative storytelling, this paper focuses upon the experiences of eight adults with ABI who had participated in storytelling workshops facilitated by an advocacy organization. Following participation in the storytelling workshops, each storyteller was interviewed twice, with three shorter interviews conducted with one participant with significant communication challenges. In total, 25 interview transcripts (17 interviews plus eight transcripts of produced personal narratives) were analysed using constructivist grounded theory methods. Data analysis produced two main themes and sub-themes; (1) Sharing and helping (feeling heard & releasing emotions) and, (2) Re-visiting my story (reflecting and learning). The themes capture insights into the process of storytelling and reveal the therapeutic potential of narrative storytelling when coupled with an altruistic opportunity to help others through story sharing. This study contributes to an emerging area of research and practice supporting positive identity growth following ABI. The findings present substantial implications for goal setting and meaningful productive engagement in brain injury rehabilitation.