Therapeutic Goal Setting Research Articles

ICF classification of therapeutic goals for outpatient episodes of neurorehabilitation in post-stroke and Parkinson disease

Purpose To understand therapeutic priorities, a secondary data analysis on a retrospective cohort was conducted to classify rehabilitation goals according to the International Classification of Functioning, Disability, and Health (ICF). Materials and Methods Therapeutic goals from an initial outpatient physical or occupational therapy evaluation for patients post-stroke or with Parkinson disease, were classified into Level 1 of the ICF. Goals in the Activity and Participation component were further sub-classified as activity capacity or activity performance (self-report or direct) in daily life. Results 776 goals across 104 participants were classified into Level 1 of the ICF. The majority, 73% (563/776) were classified as Activity and Participation, 20% (155/776) as Body Function and 2% (17/776) as Environmental Factors. Fifty-two percent (400/776) of all goals were classified as activity capacity and 21% (163/776) as activity performance in daily life, with 21% (160/776) of goals measuring self-report activity performance in daily life and less than 1% (3/776) of goals measuring direct activity performance in daily life. Conclusions While the majority of therapeutic goals were classified into the Activity and Participation component, less than 1% of goals measured direct activity performance in daily life. If people seek outpatient rehabilitation to improve functioning in their real-world environment, therapeutic goal setting should reflect this.

Heavier Load Alters Upper Limb Muscle Synergy with Correlated fNIRS Responses in BA4 and BA6.

In neurorehabilitation, motor performances may improve if patients could accomplish the training by overcoming mechanical loads. When the load inertia is increased, it has been found to trigger linear responses in motor-related cortices. The cortical responses, however, are unclear whether they also correlate to changes in muscular patterns. Therefore, it remains difficult to justify the magnitude of load during rehabilitation because of the gap between cortical and muscular activation. Here, we test the hypothesis that increases in load inertia may alter the muscle synergies, and the change in synergy may correlate with cortical activation. Twelve healthy subjects participated in the study. Each subject lifted dumbbells (either 0, 3, or 15 pounds) from the resting position to the armpit repetitively at 1 Hz. Surface electromyographic signals were collected from 8 muscles around the shoulder and the elbow, and hemodynamic signals were collected using functional near-infrared spectroscopy from motor-related regions Brodmann Area 4 (BA4) and BA6. Results showed that, given higher inertia, the synergy vectors differed farther from the baseline. Moreover, synergy similarity on the vector decreased linearly with cortical responses in BA4 and BA6, which associated with increases in inertia. Despite studies in literature that movements with similar kinematics tend not to differ in synergy vectors, we show a different possibility that the synergy vectors may deviate from a baseline. At least 2 consequences of adding inertia have been identified: to decrease synergy similarity and to increase motor cortical activity. The dual effects potentially provide a new benchmark for therapeutic goal setting.

Illness Experiences of Chilean Women With Sjögren's Syndrome: The Patient Perspective.

Sjögren's syndrome (SS) challenges everyday functioning and well-being. The aim of this study was to structure and summarize the life experiences of Chilean women with SS in an integrated model. Interviews from a previous study yielded 75 experiences of living with SS. A sample of 30 women with SS sorted these experiences by content and rated their level of agreement with each experience. A hierarchical cluster analysis was used to structure the experiences of the participants with SS in a comprehensive overview. A team-based consensus analysis was used to define the number of clusters. The level of agreement was examined with Wilcoxon's signed rank test. Ten clusters were identified and grouped into 6 main categories: symptoms (clusters: mucosal dryness and related symptoms), social environment, emotion management (clusters: fears and sadness), information (clusters: uncertainty and lack of knowledge), coping strategy (clusters: resilience and self-care), and health staff relationship. The clusters that describe the more common experiences among patients were resilience, self-care, uncertainty, lack of knowledge, health staff relationship, and mucosal dryness. This study provided an integrated and structured overview of disease experiences comprising both biomedical and psychosocial aspects as being of vital importance for the health of patients with SS. The overview can be used to get a quick impression of disease experiences that are important for an individual patient, in a therapeutic goal setting, and in the construction and evaluation of medical and nonmedical interventions or education.

PHYSICAL THERAPISTS’ PERCEPTIONS OF ADOLESCENT IDIOPATHIC SCOLIOSIS TREATMENT

Background:Few studies have demonstrated the benefit of physical therapy in the treatment of adolescent idiopathic scoliosis (AIS), alone or in conjunction with bracing or surgery. To our knowledge, there is no consensus in pediatric physical therapists who treat AIS patients.Purpose:To identify the optimal physical therapy practices for AIS including; weekly frequency, session length, treatment duration, clinical interventions, therapeutic goal-setting, and outcome measures from pediatric physical therapists’ perspectives.Methods:A 40-question validated survey, The Analysis of the Schroth Method in Adjunct to Physical Therapy Services for Treatment of AIS, was distributed to pediatric physical therapists across the country via the Academy of Pediatric Physical Therapy electronic newsletter and via dissemination by the Injury Prevention Research Interest Group from Pediatric Research in Sport Medicine. REDCap was used to collect and organize responses. The responses were analyzed by a descriptive statistics using percentages (%).Results:Sixty-five responses were obtained. The majority of physical therapists, 78.5%, were Doctors of Physical Therapy (DPT), treating 1-5 AIS patients a week (69.2%), and 18.8% had Schroth certification. Preferred treatment frequency was twice a week (41.5%) for a duration of 60 minutes (53.8%), over the course of 3-5 months (44.6%). The top three common clinical interventions were; core and trunk stability enhancement (90.8%), abdominal strengthening (83.1%) and postural correction (80.0%). The three most common therapeutic goal-setting parameters were activity based (78.5%), quality of life measure based (56.9%), and therapy participation based (50.8%). Additionally, for outcome measures, patient reported outcome was the most common objective measurement (78.5%), followed by pain (63.1%), manual muscle testing (46.2%), range of motion (44.6%), cobb angle (27.7%), scoliometer readings (26.2%) and Adam’s forward bend test (10.8%). Therapists often monitored progress with completed surveys by patients. However, patients’ ability to return to activity was the most common marker of improvement (72.3%). Patient’s scoliosis was often being treated in another manner aside from PT (46.2%), and many patients had medical conditions in addition to scoliosis (52.3%).Conclusion:According to our data, pediatric physical therapists believe that patients with AIS can benefit from physical therapy treatments addressing core and trunk stability, abdominal strengthening, and postural correction. Ideal treatment sessions would occur twice a week for 60 minutes over a period of 3-5 months. Objective measurements can be monitored to ensure improvements in quality of life, pain, strength, range of motion and curvature of the patient’s spine.AcknowledgementsThe Injury Prevention Research Interest Group from Pediatric Research in Sports Medicine and Suzanne M. McCahan, PhD

Changing the narrative for hearing health in the broader context of healthy living: a call to action

Objective To discuss the steps necessary to facilitate hearing health care in the context of well-being and healthy living Design Common themes among the articles in this special supplement of the International Journal of Audiology were used to identify issues that must be addressed if audiology is to move from being hearing-focussed to taking a holistic perspective of hearing care in the context of healthy aging. These are discussed within the context of other published literature. Results and conclusions Three needs were identified: (i) Increased interdisciplinary education to raise awareness of the interplay between hearing and health. (ii) Increased emphasis on counselling education in audiology programs so that audiologists are equipped with the knowledge, competence and confidence to provide counselling and emotional support to their patients, beyond care. (iii) Redefinition of therapeutic goal setting and hearing outcomes to include aspects of well-being, so that audiologists can capture and patients realise that that good hearing outcomes can have a direct positive impact on a person’s quality of life that extends beyond their improved ability to hear. It was emphasised that each of these needs to be considered within the context of the audiologists’ scope of practice and audiologists’ well-being.

The clinical and therapeutic challenge of treating older patients in clinical practice.

Due to the demographic shift complex care management of older multimorbid patients with changing functional capacities has become core clinical business for many stakeholders in western health care systems. It is the aim of the mini‐review to summarise evidence to be translated into clinical practice for pharmacists and medical doctors and interested readers. The review is based upon a comprehensive literature review in PubMed and EMBASE from 2000 to 2018 and grey literature. Interprofessional exchange and discussion among stakeholders from geriatric medicine and the International Association for Pharmaceutical Technology during a meeting in Graz, Austria 2018, led to the narrowing of the review addressing complex care needs of geriatric patients. In this mini‐review, attention is drawn to a comprehensive therapeutic goal setting according to evidence‐based guidelines: clinical, disease‐related care aspects, functional capacities, evaluated by comprehensive geriatric assessment, and patient's wishes and perspectives as main drivers for personalised complex care of geriatric patients.

Reflections on the design, implementation, and adoption of a gamified eHealth application in youth mental healthcare

We designed and implemented a gamified eHealth application for youth mental healthcare, to study how game design techniques could be applied within this context. This resulted in the design of a gamified mobile application aimed at supporting therapeutic goal setting: the ReadySetGoals game. The design process itself involved four key stages: (1) Identifying the transfer effect to be aimed-for, (2) Exploring the user context, (3) Designing the gamification, and (4) Evaluating the gamification. Following a preliminary evaluation, we applied a final design iteration to the app that was implemented in therapeutic practice. However, fewer therapists than expected used the app when given the opportunity and information. In a series of qualitative interviews, we investigated their reasons for not using it. Analysis of the results generated three themes that inhibit eHealth adoption: (1) Fittingness of gamification with individual users, (2) Fittingness of eHealth with face-to-face practice, (3) Distortion of therapeutic alliance by eHealth and gamification. Based on these outcomes and our design process we identified the following three recommendations to enhance implementation and adoption of eHealth in mental healthcare: (1) Align expectations of stakeholders through framing (2) Integrate therapeutic aspects in gamification, and (3) Focus on personalisation.

Awareness and satisfaction of therapeutic goals on functional status in persons with hemiparetic stroke

Objective: Setting therapeutic goals assist to identify patient priorities and predict problem that may arise in performing daily and functional activities. Goal setting is associated with improved rehabilitation outcomes in individuals with hemiparetic stroke. This study was conducted to assess the effects of having awareness and satisfaction of goals on the functional status of individuals with hemiparetic stroke. Design: Cross-sectional study. Methods: Eighty-one people who had been diagnosed with stroke participated in this study. The study was conducted through a face-to-face surveys to identify participants’ awareness and satisfaction of goals and standard assessment tools were used to evaluate patients’ functional status. This study measured functional status through three clinical measures including the manual function test (MFT), Berg Balance scale (BBS), and modified Barthel index (MBI). Results: In participants with hemiparetic stroke, the MBI, BBS, and MFT scores were significantly higher in the participants who were aware of the therapeutic goal than in those who were unaware (p<0.05). The MBI, BBS, and MFT scores were not significant between the participants who were satisfied with the goal and those who were unsatisfied. Conclusions: This study suggests that having awareness in therapeutic goal-setting could lead to improvement of functional status in those with hemiparetic stroke. This study highlights how goal-setting can have a positive effect on persons with hemiparetic stroke.

Preparing for the future: multi-stakeholder perspectives on autonomous goal setting for adolescents with autism spectrum disorders

Purpose: Self-determination is linked to numerous positive outcomes including improved social inclusion and quality of life for adolescents with autism spectrum disorder. Autonomous participation in therapeutic goal setting is an important component of self-determination. This study examined perceptions of, and barriers to, autonomous goal setting as perceived by: (1) adolescents with autism spectrum disorder, (2) parents of adolescents with autism spectrum disorder, and (3) interdisciplinary professionals.Method: Three focus groups (one with each of the key stakeholders) and one joint parent and child interview were conducted. All discussions were audio‐recorded, transcribed verbatim and thematically analyzed based on the methods outlined by Braun and Clarke (2006).Results: A total of 7 parents (6 mothers, 1 father), 4 youth with autism spectrum disorder, and 10 professionals participated in the study. Three themes related to current experiences with goal setting emerged: (1) purpose, (2) barriers, and (3) types.Conclusions: Currently, adolescents with autism spectrum disorder are rarely active participants in the goal setting process. This study provides novel data, from the perspectives of multiple stakeholders, about barriers, perceptions, and actualities related to autonomous goal setting for adolescents with autism spectrum disorder.Implications for rehabilitationAdolescent participation in autonomous goal setting is an important component of self-determination.Rehabilitation professionals, parents, and adolescents with autism spectrum disorder identified similar barriers to autonomous goal setting.Adolescents with autism spectrum disorder described goals as short-term, concrete tasks, whereas parents perceived involvement in goal setting as a gateway to long-term self-determination.Rehabilitation professionals and parents acknowledged the benefits and advocated for increased involvement of adolescents with autism spectrum disorder in the goal setting process.Similar to the paradigm shift toward family-centered care, rehabilitation professionals need to shift to include the involvement and participation of individuals with autism spectrum disorder.

Collaborative goal setting with and for children as part of therapeutic intervention

Purpose: This study explored collaborative goal setting with children, parents, and teachers, and children’s reasons for their goals based on their perceived self-efficacy, using the Austrian–German Perceived Efficacy and Goal Setting System (AG-PEGS). Method: Thirty-eight children from age 5 to 10 years (referred to occupational therapists because of difficulties in performing everyday activities), their parents and teachers participated in this mixed methods study. Participants’ goals were analyzed using descriptive statistics and content analysis. Data were grouped into thematic categories, and attributed to health factors according to the International Classification of Functioning, Disability, and Health-Children & Youth Version (ICF-CY).Results: Children’s responses underlined the significance of self-efficacy and participation for a child’s health and well-being. They gave priority to their independence, competence, and joy in meaningful everyday activities and indicated social motives such as belonging to and being accepted by others for their mainly participation-oriented goals. Parents’ main concerns were related to school task performance, whereas teachers mainly chose body functions and school activities to be the focus of occupational therapy intervention.Conclusions: Exploring clients’ priorities, the meanings they attributed to activities in daily life, and their underlying motives for goals should be part of therapeutic intervention. Children and their caregivers are valid and important sources for therapeutic goal setting. Basic human needs, e.g., for relatedness, competence (self-efficacy), autonomy, and meaningful personal orientation, should be considered when prioritizing goals for intervention.Implications for RehabilitationChildren are a valid and important source for therapeutic goal setting.Children’s goals focused on activities and participation in all life areas, and half of the parents’ goals on activities as relevant for productivity (followed by self-care and leisure), while teachers tended to prioritize goals at the body functions and structures level.The experience of their task performance affecting participation, and the basic needs for independence, relatedness (belonging to and being accepted by others), competence (self-efficacy), and joy through engagement in personally meaningful activities are main motives for children with developmental disabilities to choose their goals for intervention.A client-centred approach in working with children with developmental disabilities requires time and attention for exploring meaning-attributed activities for children and their proxies when collaboratively setting goals.

ACHPN Certification Review: Advanced Practice Registered Nurse (P06)

Utilize an evidence-based approach to medication prescribing process, including specifically how to discontinue medications for patients with serious illness. Integrate effective communication skills concerning medication management in patients with an advanced illness, with providers, patients, families and caregivers. Medications play a very large role in the management of chronic illnesses in advanced illness. The purpose of this all-day preconference is to wrestle with optimizing medication management in the most common advanced illnesses at the end of life including metabolic syndrome, heart failure, COPD, dementia, ALS and other disease states. Particular attention will be paid to medication-related issues in transitions of care between palliative care and hospice care, including medication and dosage formulation selection, therapeutic goal setting, monitoring and dosage titration aimed at optimizing symptom control.

FRI0297 The burden of dryness. a comprehensive overview from the perspective of patients with sjögren’s syndrome

BackgroundThe chronic autoimmune disease Sjögren’s syndrome is characterized by infiltration of the exocrine glands. The resulting dryness of eyes, mouth, and other parts of the body may have serious consequences...

Osteoarthritis Measurement in Routine Rheumatology Outpatient Practice (OMIRROP) in Australia: A Survey of Practice Style, Instrument Use, Responder Criteria, and State-Attainment Criteria

The purpose of the 2007 Osteoarthritis Measurement in Routine Rheumatology Outpatient Practice survey was to describe practice styles, instrument usage, and perceptions of responder criteria and state-attainment criteria in osteoarthritis (OA) management in routine clinical rheumatology practice. A 16-item questionnaire (65 subcomponents) was developed, pretested, revised, formatted, and mailed to rheumatologists residing in Australia. Responses were obtained from 136 rheumatologists (response rate 58%). Approximately half the Australian respondents did not follow up their patients with hip and knee OA and two-thirds did not follow up their patients with hand OA. Health status measures (HSM) were infrequently used, even by those respondents who followed their patients with OA longitudinally, and the scores from those HSM that were used, were rarely if ever formally recorded. Respondents rated the following 6 requirements of a measure for use in clinical practice as very important: validity, reliability, responsiveness, simplicity, quick completion, and easy scoring. One-fifth to one-quarter of respondents indicated they did not know quantitatively what constituted a clinically important improvement, or a health state acceptable to patients with OA. The majority of the remainder selected values not closely aligned with published values in the peer review literature. While simply describing the health status of the patient is interesting, the more strategic applications are in benchmarking, and using the data to inform shared decision-making and therapeutic goal-setting. The OMIRROP survey suggests that further investigation of interpretation issues are essential, before evaluating the role of quantitative measurement in routine OA clinical practice.

Improving Goal Setting and Goal Attainment in Patients with Chronic Noncancer Pain

Chronic noncancer pain (CNCP) is a major problem in health care today. Management of patients who have CNCP often poses a challenge for health care providers because their goals are nonspecific and as a group they are prone to frustration and depression. This article evaluates the characteristics of therapeutic goal setting, barriers to goal setting, and potential solutions to this problem. If the patients with CNCP can be assisted to set realistic goals, both patient care and its outcomes will improve.

Ego Development and the Therapeutic Goal-Setting Capacities of Mentally Ill Adults

What capacity do chronically mentally ill adults have for envisioning personal development as evidenced by the ability to set therapeutic goals? This study explored how individual differences in ego development (Loevinger, 1976) predict the therapeutic goal-setting capacities of adults with chronic mental illness receiving therapy in a community mental health setting. The sample included 51 men and 49 women, ages 25 to 65, diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. Utilizing correlational and multiple regression analyses, results confirmed a relationship between higher stages of ego development and greater complexity of therapeutic goals, as well as greater commitment to therapeutic goals. Rehabilitation goals were more prevalent at lower stages of ego development, while goals such as enhancing one's personal relationships, and gaining increased insight emerged at higher stages. Implications for therapeutic change are discussed.

Motivating offenders to change in therapy: An organizing framework

Objectives. Motivating offenders to change in therapy is an important aspect of effective offender treatment, yet despite this, offenders' motivation to change has received little close attention in the academic and professional literature. This situation is a result of an over‐emphasis on the risk management model of rehabilitation, and a consequent failure to construe motivation within an overarching theory of offender rehabilitation.Method. We present a social cognitive model of offender motivation — the Good Lives Model (GLM) — that provides a framework for incorporating factors that have been shown to be of importance in enhancing offender motivation. This is based upon the notion that all humans strive to achieve primary goods that are intrinsically rewarding and essential to well‐being. Where offenders are concerned, criminogenic problems relate, not to the goods offenders seek, but to the way they seek them. Any treatment approach should take this into account and focus positively on equipping people with the skills required to achieve goals rather than simply look to manage risk. The motivational construct that we use here is that of goals. In the GLM, goals are the less abstract depictions of primary human goods and it is with these that people are typically engaged in their day‐to‐day activities and lives. Looking at therapeutic goal‐setting, methods and styles of therapy, and therapist approaches, we derive theoretically‐based key issues in motivating offenders to change in therapy.Conclusion. In conclusion, we present a summary of 12 strategies and techniques that will not only help practitioners enhance their therapeutic effectiveness, but hopefully also act as a catalyst in the development of research on offenders' motivation to change.

Meaning and misunderstanding in occupational forms: a study of therapeutic goal setting.

This study examined occupational therapists' use of the occupational form of goal setting as therapy and its impact on clients. The study method was qualitative, using participant observation and interviewing as the main source of data. The findings illustrated that therapists work both to give substance to the occupational form and to create the context of an implied narrative that imbues it with particular meanings. Simultaneously, clients' experience of meaning is influenced by a personal volitional narrative. When the two narratives do not coincide, therapists' efforts to maintain the occupational form intensify as they encourage clients toward attitudes and performances that do not resonate with the clients' experience of reality. The findings underscore the importance of recognizing that occupational forms are embedded in social processes and perspectives that inevitably come into play when occupational forms are used as therapy.

Gesellschaftlicher Wandel und psychotherapie

While dynamic psychiatry in itself represents one of the great intellectual advances of the 19th and 20th centuries, it has neglected two areas of social change which are of importance for the therapeutic task. Changes in the position of men and women in Western civilization which give great decision power to women and impose a high degree of dependency on men are presented as pathology and ineffectively attacked by the setting of treatment goals which follow archaic models. Such goal setting burdens not only the patient but also the therapist with inappropriate assignments. The changing position of the United States from a spearhead of revolutionary idealism to a world power with essentially conservative interests has caused much conscious conflict among patients and therapists to which psychiatry has not yet responded as a mental health challenge. Here again, obsolete models interfere with the effectiveness of therapeutic goal setting.