Goal setting in neurological rehabilitation: Staff perspectives

Royston Hospital, London Road, Royston, Herts SG8 9EN, UK.
Disability and Rehabilitation (Impact Factor: 1.99). 01/2010; 32(17):1419-27. DOI: 10.3109/09638280903574345
Source: PubMed


The purpose of this study was to explore rehabilitation professionals' perspectives about goal setting, and more particularly, the use of two specific forms of goal setting used within the same setting; 'usual participation' and 'increased participation'.
A qualitative research approach was identified as being particularly pertinent for the aims of this study. Fifteen rehabilitation professionals representing five different professions and having experience of usual and increased participation goal setting approaches used in one Neurological Rehabilitation Unit participated in two focus groups. The focus group questions were designed to elicit staff views about goal setting generally, and to invite comparison regarding their experiences of using two goal setting approaches. The focus group transcripts were analysed according to thematic analysis principles.
Five themes were identified: the goal setting tools (including views about the folder developed for one form of goal setting); barriers to goal setting (including lack of time, professional group work patterns and lack of experience), the keyworker role (including prerequisites for effective keyworking); patient characteristics (disease, personality and expectations); and the nature of goals.
Whilst the 'increased participation' mode of goal setting was seen as having the potential to allow patients a stronger voice within the goal setting process, both time and resources are required to ensure that this potential is fully realised.

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    • "We found that some participants reported difficulties with articulating specific rehabilitation goals, and that health professionals experienced that goal setting could be a challenging in HD. Goal setting is a core skill of rehabilitation professionals, and is considered as an essential component of any modern approach to rehabilitation [21, 22]. Studies suggest that patients’ experience of the rehabilitation process is significantly better, and that the nature of rehabilitation goals changes when patients are involved in goal setting [23]. "
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    ABSTRACT: Background Research suggests that rehabilitation is beneficial for persons with Huntington’s disease (HD), but there is limited knowledge about participants’ experiences with residential rehabilitation programs. We therefore did a study to explore patients’, family caregivers’, and health professionals’ experiences with a group-based, residential rehabilitation program for individuals with early to mid-stage HD, focusing on three research questions: How did participants experience the structure and content of the program? What outcomes did patients experience? What challenges and success factors did health professionals report? Methods Qualitative, explorative study, collecting data through in-depth interviews with nine family caregivers and 11 patients with early- and mid-stage HD, and focus group interviews with 15 health professionals. Data were analysed using systematic text condensation. Results Some participants reported difficulties with defining individual rehabilitation goals, but written individualised plans and schedules were appreciated by all participants. Participants highlighted being member of an "HD-group" as a valuable experience, though tensions and conflicts could occur in groups. Participants typically reported improved gait and balance, increased self-confidence, and social benefits as outcomes. The intensive schedule was acceptable for most participants, but adjustments had been made to allow participants more time to eat, shower and dress between sessions. Success factors reported by health professionals were assigning every patient with a contact person, using clinical tests results to motivate patients, and supervising health professionals in patients’ local municipalities. Conclusions Group-based residental rehabilitation was feasible for individuals with early- and mid-stage HD, and participants emphasised mental and social outcomes in addition to physical outcomes. The needs of persons with HD should be considerd when designing programs, to secure structure, continuity in personnel, and sufficient time between sessions.
    BMC Health Services Research 09/2014; 14(1):395. DOI:10.1186/1472-6963-14-395 · 1.71 Impact Factor
    • "The advantages of goal-setting for the clinician include enhanced teamwork , greater workplace efficiency, providing structure to treatment, and increasing clients' motivation (Doig, Fleming, Cornwell, & Kuipers, 2009; Levack et al., 2006a; Playford, Dawson, Limbert, Smith, Ward, & Wells, 2000). In contrast, client-centred goal-setting has been noted to be time-consuming, thereby detracting from treatment time; in addition, clinicians have also voiced how demanding the process is of establishing a meaningful relationship on which goal-setting can be based (Levack et al., 2006a; Playford et al., 2000; Scobbie et al., 2011; Van De Weyer et al., 2010). "
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    ABSTRACT: In this theoretical paper, we argue that the adoption of the social model to aphasia rehabilitation within group settings changes the metaphorical location of the boundaries between clinicians and clients. Despite a growing literature on group work for aphasia and social model applications for people with chronic aphasia, there has been almost no attention paid to how professional boundaries are negotiated. This paper reviews how this issue is dealt with within professional codes of ethics and what is written more broadly on professional boundaries, and then uses a number of real case examples to encourage further discussion and awareness of this important issue in aphasia rehabilitation within group settings.
    International Journal of Speech-Language Pathology 04/2010; 12(2):152-61. DOI:10.3109/17549500903521806 · 1.24 Impact Factor
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    ABSTRACT: This paper discusses different ways of enhancing patient-therapist dialogues using a new visualisation tool for rehabilitation, which provides patients with a visual and interactive interface to observe and understand their own movements. The opportunities for using the tool in both clinical and home environments are discussed.
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