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.
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    Pervasive Computing Technologies for Healthcare (PervasiveHealth), 2011 5th International Conference on; 06/2011
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    ABSTRACT: Goal-setting is considered an essential part of rehabilitation practice and integral to person-centredness. However, people with aphasia are not always satisfied with goal-setting, and speech-language pathologists are concerned about the appropriateness of therapy. Furthermore, family members are often excluded from goal-setting, despite the impact aphasia has on them. The actual goals set by clinicians for clients with aphasia and their family members have not yet been investigated. This study aimed to examine the goals that clinicians set for their clients with aphasia and their family members. Data from in-depth interviews with 34 speech-language pathologists describing 84 goal-setting experiences with people with aphasia were coded into superordinate goals for both groups. Clinicians expressed a wide range of goals for people with aphasia and their family members, relating to communication, coping and participation factors, and education. In addition, evaluation was considered a goal for the clients. There were clients for whom no goals were set, particularly for family members, due to a lack of/limited contact. The goals described broadly addressed all aspects of the International Classification of Functioning, Disability and Health (ICF) and reflected the use of both functional and impairment-based therapeutic approaches; they also emphasize the importance of providing goal-setting options for the family members of these clients.
    International Journal of Speech-Language Pathology 08/2011; 13(4):317-28. DOI:10.3109/17549507.2011.584632 · 1.24 Impact Factor
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