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Clinical Rehabilitation 2003; 1 7: 192–202
© Arnold 2003 10.1191/0269215503cr599oa
Address for correspondence: KP Sivaraman Nair, DP&NR,
National Institute of Mental Health and Neurosciences,
Hosur Road, Bangalore 560 029, India. e-mail: kpsnair@
hotmail.com
Life goals: the concept and its relevance to
rehabilitation
KP Sivaraman Nair Rivermead Rehabilitation Centre, Oxford, now at Department of Psychiatric and Neurological
Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, India
Received 7th July 2001; returned for revisions 4th October 2001; revised manuscript accepted 27th October 2001.
Objective: Life goals are desired states that people seek to obtain maintain or
avoid. These goals may inuence motivation to participate in the rehabilitation
process. The aim of this paper is to review the literature on life goals and the
inuence of life goals on the rehabilitation process.
Methods: The MEDLINE, EMBASE, Psychlit and CINAHL databases were
searched with the keywords goals, life goals, aim of life, meaning of life,
motivation, assessment (identication) of life goals, goal planning, disability,
coping and rehabilitation.
Results: The initial search produced 917 abstracts. After going through these
abstracts, 39 articles were selected for inclusion in the review. Age, gender,
personality, experiences and society and environment inuence life goals.
Pursuit and attainment of life goals affect sense of well-being. Life goals are
accessible to conscious awareness and can be identied. Several
questionnaires are available for assessment of life goals. Different
questionnaires assess different aspects of life goals. All except one of these
questionnaires need to be tested for validity and reliability in a rehabilitation
setting. Disabilities interfere with goal striving and result in emotional
distress. Motivation to participate in a rehabilitation programme depends on
concurrence between a patient’s life goals and treatment goals. Incorporation
of a subject’s life goals into a management programme resulted in better
outcomes in various physical and psychiatric disorders. There are no data on
the efcacy of life goal-orientated rehabilitation programmes.
Conclusions: Life goals inuence patients’ motivation to participate in and
compliance with treatment programmes. We still do not know whether
rehabilitation programmes focusing on life goals make any difference in
outcome. There is need for further studies in this area.
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Life goals and rehabilitation
193
Introduction
The concept of life goals was introduced in 1970s
as a dimension of motivation. Since then an
extensive volume of knowledge about life goals
has accumulated in the elds of psychology,
social work and rehabilitation. Life goals are the
desired states that people seek to obtain, main-
tain or avoid.
1
These goals are the ends that indi-
viduals try to achieve by means of their cognitive
and behavioural strategies. They are modied by
personal and contextual factors. Diseases and dis-
abilities interrupt the pursuit of life goals, result-
ing in emotional distress.
2
The motivation of a
person to participate in the rehabilitation process
depend on concurrence between the treatment
goals and the subject’s life goals.
3
Goal-orien-
tated treatment programmes were found success-
ful in rehabilitation.
4
The aim of this paper is to review the litera-
ture on life goals and the inuence of these goals
on the process of rehabilitation. The paper
describes the methods used for literature search,
results and conclusions. The results are divided
into sections dealing with the nature of life goals,
factors inuencing life goals, effect of life goals
on health, impact of illness on life goals, tools for
assessment of life goals and role of life goals in
rehabilitation.
Methods
The MEDLINE, EMBASE, Psychlit and
CINAHL databases were searched with the key-
words goals, life goals, aim of life, meaning of
life, assessment (identication) of life goals, goal
planning, disability, coping and rehabilitation.
Abstracts of all results were read. Articles deal-
ing directly with the nature of life goals, assess-
ment of life goals, factors inuencing life goals,
inuence of life goals on health, effect of illness
and disabilities on life goals, methods of assess-
ment of life goals and signicance of life goals to
rehabilitation were selected. The reprints of these
articles were obtained and read in full.
Results
The search of databases revealed 917 abstracts.
Reprints of 72 articles were obtained and read.
Thirty-nine references directly dealing with the
subject were included in the review.
Life goals
Nature
Life goals consist of a complex hierarchy
(Table 1).
2,5–9
At the top of this hierarchy is an
overriding reference value or idealized self-
image. The desire to attain this idealized self-
image leads to abstract motivations like need for
power, fame, esteem, independence and pride.
8,10
The personal goals or middle-level goals are tasks
or objectives determined by these abstract moti-
vations. They are easily recognized and expressed
by the individuals and are amenable to measure-
ment. They include goals like career, relation-
ships and nancial security.
7,8
The contextual
goals are an individual’s conscious intentions and
actions to orient their current environment or life
situations towards personal goals.
7
Examples
include striving for better grades at school,
attempting to perform well at sports, and trying
to improve relationships. The lowest level of hier-
archy of life goals consists of immediate actions
and discrete events that will lead to contextual
goals. They include specic actions like reading,
writing, driving, etc.
7
Setting of goals at any level
is determined by the goal of the next level up in
hierarchy.
6,9
The fullment of lower level goals
leads to realization of higher level motivations
Table 1 Hierarchy of life goals
Level Goal Examples
1 Idealized self-image
2 Abstract motivations Power, fame, fortune
3 Personal goals Career, family, relationships
4 Contextual goals Striving for better grades at school
5 Immediate actions Specic activities like reading, writing, playing
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194
KP Sivaraman Nair
Absence of life goals results in a sense of mean-
inglessness leading to nihilism, cynicism, apathy
and suicidal ideas.
18
The nature of goals also
inuences emotional well-being. A preoccupation
with achievement-related goals to the exclusion
of relationship goals results in stress. Extrinsically
orientated goals like nancial status and social
standing were negatively related to sense of well-
being.
1
High levels of goal striving were associ-
ated with depression.
19
How people handle the
conicts while striving towards life goals inu-
ences their sense of well-being. The degree to
which individuals experienced positive or nega-
tive moods on a day was related to occurrence of
events facilitating or inhibiting life goals.
17,19
Life goals and illness
Illness and disability interfere with pursuit of
life goals and will result in emotional distress.
2
Shih
et al
. noted that unnished responsibilities
and unattained life goals were the primary con-
cerns of patients admitted for cardiac surgery.
20
Roberts
et al
. observed that diagnosis of cancer
interferes with the life goals of young adult
patients and leads to psychological symptoms.
21
Cook noted that patients with spinal cord injuries
had negative perceptions towards important life
goals.
22
The life goals may be inuenced by phys-
ical symptoms. Karoly and Lecci noted that per-
sons experiencing persistent pain tend to
evaluate their life goals in a problematic fash-
ion.
23
The presence of pain was associated with
lower ratings of self-efcacy, self-monitoring,
self-reward and less positive arousal.
McGrath and Adams
2
used Carver and
Scheier’s
9
model of affect in relation to informa-
tion processing to explain the emotional impact
of brain injury on life goals. According this model
the current action is undertaken to minimize the
discrepancy between the current state and some
behavioural reference (goal). Affect is experi-
and in turn help the individual to move closer to
the idealized self-image.
6
Inuences
These goals are modied by various factors
like age, gender, personality, affect, environment
and health.
5
An individual’s life goals change
from early adulthood to late life (Table 2).
6
Gen-
der inuences choice of life goals: women tend to
give more importance to family, domestic and
social goals, and men to economic goals and
occupation.
7,11
Pregnancy is a major life event
that signicantly inuences and is inuenced by
life goals. Parenting demands adjustment of life
expectations. A study by Hudspeth
et al
. found
that the pregnant teenagers had fewer life goals
than their peers.
12
Personality plays an important role in choice
of life goals. Personality traits of extroversion and
narcissism were correlated positively with goals
of economic success, exciting lifestyle and presti-
gious occupation, and negatively with social goals
like working for welfare of others.
7
People with
type A behaviour were more often dissatised
with their attainment of life goals.
13
The person-
ality traits may be viewed as those facilitating or
thwarting the pursuit of life goals.
14
Certain per-
sonality traits may result in failure to utilize social
support in goal striving. Life goals are also inu-
enced by earlier negative or positive experiences.
Unemployed subjects with end-stage renal failure
had more negative attitudes to life goals, and
reported greater loss of life goals.
15
Life goals and health
Life goals contribute to health and psycholog-
ical well-being. Several studies have shown that
people with a high sense of well-being had bet-
ter recognition of life goals, commitment to life
goals, perception of progress towards life goals
and sense of achievement of life goals.
10,16,17
Table 2 Goals and stages of life
6
Early adulthood Middle age Late life
Education Carrier Health
Finding occupation Income Retirement
Selection of partner Meeting demands of parenthood Adjusting to reduced income
Starting family Nurturing marriage Coping with bereavement
Finding congenial social groups Managing household Religion and life philosophy
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Life goals and rehabilitation
195
enced when the rate of approach to goal is dif-
ferent from the desired rate. The distance from
the goal is less important than the rate at which
the goal is approached. When the actual rate of
approach exceeds the desired rate positive emo-
tions are experienced and where rate is slow neg-
ative emotions are experienced. The intensity
and type of emotion are related to the signi-
cance of goals and the magnitude of the rate of
discrepancy. Acute brain injury results in a sud-
den dramatic interruption of goal-directed activ-
ity. This is followed by a gradual and steady
resumption of some activities in some life areas.
In the chronic progressive conditions, the rate of
approach to desired goals is unpredictable. Thus,
neurological disorders have a signicant negative
impact on goal striving, resulting in emotional
distress.
McGrath and Adams noted frustration, sad-
ness, fear, confusion and worry among subjects
with brain injury.
2
Frustration was the initial
response to interruption or slowing of rate of
approach to desired goal. Sadness or depression
resulted from failure to attain a goal. Subjects
experienced fear when slowing of rate of
approach to a goal is anticipated, especially
where the goal relates to self-preservation. Worry
was the explicit cognitive aspect of monitoring
the rate of approach to the desired goal. Confu-
sion occurs when the monitoring process is dis-
rupted because of misinformation or cognitive
problems. The emotional distress described by
these patients arises partly from slowing, inter-
ruption or uncertainty of rate of approach to per-
sonally meaningful goals.
2
Assessment of life goals
The techniques used to study life goals are
qualitative methods, life goals questionnaires and
questionnaires assessing commitment to life goals
(Table 3). The personal quest for a meaningful
life and life goals can be analysed using written
narratives The subjects were asked to write about
the life goals and meaning of their life. The writ-
ten descriptions were analysed using predeter-
mined criteria. It was possible to test hypothesis
and obtain statistically signicant reproducible
ndings by this method.
24
Goals specify what a
person typically is trying to do. Craik used video
recordings of person environment transactions
during a lived day to analyse life goals.
14
Various questionnaires are used to identify life
goals. Nurmi
6
and King
et al
.
17
used open-ended
questionnaires in which the subjects were asked
to list their goals of life. In the study by Nurmi,
the subjects were asked to write down their goals,
hopes, plans and dreams in four numbered lines.
6
The goals and concerns were classied indepen-
dently by two assessors into one of 15 categories.
The categories were: occupation, property, fam-
ily, marriage, self, education, health, travel, chil-
dren’s life, leisure activities, world, retirement,
war, health of others, friends and others. King
et
al
. allowed subjects to list as many goals as they
wished in one page.
17
Examples of common life
goals given by the participants of this study were
‘nd a loving spouse’, ‘have two children’,
‘remain close to family’, and ‘be a successful pae-
diatrician’. The number of goals listed varied
from two to 30 (mean 7.9, SD 6). The open-ended
questionnaires elicit self-articulated personal
goals.
Table 3 Methods for assessment of life goals
Qualitative methods to identify Questionnaires to identify life Measures of commitment to life
life goals goals goals
Recorded interviews and Open-ended questionnaires
6,17
Purpose in Life Test
1,10,12
written narratives
24
California Life Goals Evaluation Life Regards Index
18
Video recordings
14
Schedule
25
Life Esteem Survey
10
Life Goals Inventory
26
Major Life Goals Questionnaire
7
Questionnaire for mail survey of
life goals
16
Rivermead Life Goals
Questionnaire
3
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196
KP Sivaraman Nair
greater meaning or purpose of life. It has good
validity and reliability and has been used for
counselling students, vocational guidance, reha-
bilitation, treatment of alcoholism and therapy
for neurosis.
10,12
Life Regards Index was an
instrument similar to the Purpose in Life Test. It
has two 14-item subscales: the framework scale
and the fullment scale. All the 28 items scored
on a Likert scale: 1 (do not agree), 2 (no opin-
ion) and 3 (agree). The framework subscale was
designed to assess the degree to which individu-
als have derived a set of life goals. The fullment
scale measures the degree to which subjects see
themselves as having fullled or being in the
process of fullling the life goals. This scale had
good validity and reliability.
18
Different scales measure different aspects of
life goals. The California Life Goals Evaluation
Schedule and Life Esteem Survey measure
mainly abstract motivations (Table 1). The valid-
ity and reliability of these two scales were estab-
lished in several studies. It may not be practical
to apply these scales in patients with brain injury,
as associated cognitive decits will interfere with
abstract reasoning. Scales used by Roberts and
Robins,
7
Hooker and Segler,
16
and Raina and
Vats
26
focus more on personal goals. The valid-
ity and reliability of these scales were not fully
studied. The Life Regards Index and Purpose in
Life Test estimate the extent to which the person
is committed to life goals. They do not identify
the life goals. The methods like analysis of writ-
ten descriptions, responses to open-ended ques-
tionnaires and recorded interviews also assess
personal goals, as these are better expressed by
individuals. The interviews are very time con-
suming and may not be feasible in subjects with
communication problems. Problems in cognition,
communication and motor control may interfere
with the ability of subjects with neurological dis-
abilities to give a good written account of life
goals. The video recordings of person–environ-
ment interactions probably gives information
about specic actions – the lowermost level of life
goal hierarchy. Cognitive, visuospatial and loco-
motion disabilities limit interactions of patients
with the physical environment. Hence this
method may not be useful in this group of clients.
These scales were studied in populations without
disabilities. The assessment of life goals in peo-
Several structured questionnaires have been
used to identify life goals. The California Life
Goals Evaluation Schedule has been used in sev-
eral studies.
8,25
This questionnaire has 150 state-
ments grouped into 10 subsections: esteem,
prot, fame, power, leadership, security, social
service, interesting experience, self-expression
and independence. The responses are rated on a
ve-point scale ranging from 1 (strongly dis-
agree) to 5 (strongly agree). The scale has good
validity and reliability.
8,25
The Life Esteem Sur-
vey measures the relative importance of 22 dif-
ferent life goals.
10
The importance of each goal is
rated on a scale of one to nine. This scale also
had good reliability and validity.
10
Roberts and
Robins assessed life goals using a questionnaire
consisting of 38 life goals arranged in seven clus-
ters.
7
The clusters were economic, aesthetic,
social, relationship, political, hedonistic and reli-
gious goals. The responses were obtained in a
ve-point rating scale ranging from 1 (strongly
disagree) to 5 (strongly agree). The study showed
a good internal consistency for the scale.
Raina and Vats used a 35-item life goals inven-
tory to collect data on life goals.
26
The subjects
rated importance of each item on a four-point
scale: 1 (of little or no importance), 2 (somewhat
important), 3 (very important) and 4 (essential).
These goals fell into three broad categories: per-
sonal, social and vocational. The validity and reli-
ability of the scale were not reported. Hooker
and Siegler used a questionnaire with seven
domains for a mail survey of life goals.
16
The
domains were: work, relationship with spouse,
relationship with parents, relationship with chil-
dren, relationship with friends, recreational activ-
ities, and civic and community activities. The
respondents rated the importance of each domain
on a four-point rating scale: 1 (not at all impor-
tant), 2 (somewhat important), 3 (very impor-
tant) and 4 (most important). This is a simple
scale, which is easy to administer. However there
were no data on its validity and reliability.
The Purpose in Life Test and Life Regards
Index measure the commitment to life goals. Pur-
pose in Life Test was a measure of sense of
meaning and purpose in life. The scores indicate
strength of a person’s overall sense of purpose.
The instrument has 20 items, which are rated on
a scale from one to seven. Higher score indicates
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Life goals and rehabilitation
197
for consistency of choices over time. Neurologi-
cal disorders often result in emotional impair-
ments such as hallucinations, delusions, anxiety
and depression. These problems may also impair
judgement and choice of life goals. It is impor-
tant to tackle the emotional problems with med-
ications, counselling or psychotherapy before
obtaining life goals. Delay the decisions regard-
ing life goals as far as possible until the emotional
state is stable. In these subjects it is also essen-
tial to make repeated assessments and to check
for consistency.
3
Life goals and rehabilitation
Spriggs noted that even in the face of devas-
tating illness people continue to make
autonomous decisions, set goals and pursue
them.
27
According to Lukas people with chronic
illness and long-term disabilities testify that life
is unconditionally worth living. There is a mean-
ingful life for every person, regardless of his or
her life circumstances.
28
Patients come to reha-
bilitation with a system of beliefs concerning ill-
ness, recovery and rehabilitation. The nature of
their expectations will depend on the patient’s
previous experience of similar situations, culture
and experiences of friends and relatives, infor-
mation given about the illness, attitudes of the
professional staff and life philosophy.
3
It is
important to establish which areas of life concern
patients most.
The success of a rehabilitation programme
depends on the motivation of its clients. Motiva-
tion depends, to a large extent on concurrence
between a patient’s life goals and the goals set by
the rehabilitation team. Many patients described
as unmotivated simply have goals different from
those of the rehabilitation team.
3
In a case study,
Kogan reported a patient who offered resistance
to psychotherapy that had goals that did not t
with the patient’s life goals.
29
It is the duty of the
team to tailor their goals to those of the patient,
not vice versa. The team must also ensure that
the patient understands and agrees that the reha-
bilitation goals coincide with their life goals.
3
Treatment programmes centred on a patient’s
life goals have been successful in the manage-
ment of several disorders. Skantze noted that
some domains of quality of life of outpatients
with schizophrenia improved signicantly with
ple with neurological disorders is complicated by
problems in communication, cognition, emotion
and motor skills. These scales were not validated
in this group.
At Rivermead Rehabilitation Centre, Oxford,
a structured questionnaire complemented by
structured interview is used to identify patients’
goals.
3
This questionnaire addresses nine aspects
or areas of life. Patients rate the signicance on
a scale of 0 (no signicance), 1 (of some signi-
cance), 2 (of great signicance) and 3 (of extreme
signicance) (Appendix). The scores on the life
goals questionnaire help the patient to indicate
the relative importance of each item. Many
patients rate several areas as extremely impor-
tant and so it is vital to ask the patient to rank
the rst three items in order if at all possible. A
preliminary study showed good test–retest relia-
bility for this questionnaire.
2
Most of the subjects
rated residential and domestic arrangements,
ability to manage personal care and family life as
of extreme importance. Financial status, work
and leisure received variable ratings. The major-
ity rated religion and life philosophy as of no
importance. Patients who had a partner rated this
area as of extreme importance. The patients gave
emphasis to relationships with partner and fam-
ily, not to work and leisure. In contrast, most
rehabilitation services place more emphasis on
work and leisure and less on family and rela-
tionships.
2
Aphasia, cognitive losses or emotional upset
may make it difcult to obtain a patient’s life
goals. Communication problems are common fol-
lowing head injury or stroke. Some idea about
patient’s life goals can be obtained from relatives
who knew the patient well, but information may
be biased. The relative may not know the life
goals and may not be aware of this fact. The
speech and language therapists have knowledge
and technical skill in obtaining relevant informa-
tion from these patients. Cognitive impairments
and lack of insight also interfere with assessment
of life goals. Loss of ability to make judgements
and abstract thinking will interrupt with formu-
lation and assessment of life goals. They may not
be able to make choices or rank multiple options.
It is essential to spend as much time as possible
with such patients. Ask them to make simple
choices and give yes or no responses and check
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198
KP Sivaraman Nair
ing facilitation of acceptance of losses and
restructuring of life goals helped in promoting
more adaptive coping. Refocusing of life goals
helped people with AIDs to cope with illness
better.
38
Quite often, patients are well aware of the dif-
culties in achieving goals they have set, but do
not acknowledge this.
39
They should be helped to
change this denial behaviour, develop a more
positive coping skill and move on to a more real-
istic goal. Many subjects do not have insight into
their problems. They do not recognize the barri-
ers of impairments and disabilities. These sub-
jects require assistance in understanding the
requirements to full their life goals, their cur-
rent and likely future situation and possible alter-
natives. This realization often causes anxiety and
emotional distress. The rehabilitation team
should help clients to cope with negative emo-
tions due to the disruption of goal striving. One
approach is to examine the relation between
unachievable goals and a person’s idealized self-
image. These goals may need to be disconnected
from the ideal self-image. Then, the failure to
achieve them will not be of emotional signi-
cance. The person can turn to a new goal domain
or adopt a less exacting standard in the same
domain.
2
Schultze and Ososke suggested that
counselling based on the principles of Brief
Therapy is useful in this setting. The intervention
consists of validation, compliment and sugges-
tion.
39
‘Validation’ is the acknowledgement of
difculties that the patient is facing in goal striv-
ing and normalizing the experience. ‘Compli-
ment’ is the recognition of their efforts in relation
to goal attainment. ‘Suggestion’ is the introduc-
tion of the task they need to perform to attain
the goals. The tasks also include change in behav-
iour, development of coping skills, obtaining
insight and focus on achieving realistic goals.
The rate of recovery from neurological disor-
ders is often slow and may not match with
patients’ expectations. It may be disappointing to
learn that recovery may take longer time than
expected. The slow rate of approach to person-
ally meaningful goals results in emotional dis-
tress.
2
The patients should be able to develop
realistic expectations about the rate at which
goals will be approached. This occurs through
provision of expert information on prognosis and
services based on patients’ life goals.
30
Thornton
and Hakkim suggested that a rehabilitation pro-
gramme focused on life goals and designed to
restore the meaningful existence of people with
end-stage renal disease improves the quality of
life and is cost effective.
31
Addition of personal
goals into a rehabilitation programme improved
the outcome of sports injuries.
32
In a randomized
controlled trial, Glasgow
et al
. noted that the
introduction of patient-centred goal setting led to
prolonged changes in dietary behaviour in peo-
ple with diabetes.
33
Setting individual goals led to
more efcient and effective tness training in
people with chronic airway limitation.
34
Bauer
and McBride suggested that a life goals group
psychotherapy programme was successful in the
treatment of bipolar affective disorders.
35
It is good practice to involve patients in setting
their own goals. Increased involvement of
patients in their process of goal planning led to
maintenance of gains made.
4
However there was
only one study directly dealing with the benets
of a rehabilitation programme centred on
patients’ life goals. McGrath and Adams noted
that patient-centred goal planning improved the
mood of the subjects.
2
Evidence on the efcacy
of the incorporation of patients’ life goals into a
rehabilitation programme is still lacking.
Figure 1 shows a owchart for a rehabilitation
programme based on life goals. The rehabilita-
tion team, using knowledge about prognosis,
available interventions, resources and environ-
ment, should assess the life goals obtained from
patients. Many of the life goals of clients may
turn out to be unrealistic and not achievable.
Subjects are required to restructure their life
goals. Coping with loss of life goals and refocus-
ing on achievable goals are essential for the suc-
cess of rehabilitation. Patients with rheumatoid
arthritis who coped by restructuring life goals
were found to have better psychological adjust-
ment and functional status than patients who
hoped for unrealistic solutions or who engaged in
self-blame.
36
Post and Collins suggested that in
patients with chronic obstructive pulmonary dis-
ease, a lack of adjustment in expectations and life
goals led to difculty in accepting illness, chronic
anxiety, attribution of responsibility to external
factors and poor compliance with medical
regime.
37
Psychotherapeutic interventions includ-
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Life goals and rehabilitation
199
Patients with disturbances in memory may need
to be repeatedly reminded about this. At River-
mead Rehabilitation Centre, patients and family
members are invited to participate in all goal-
planning meetings, except the initial one. A copy
of the summary of the meeting is also given to
them. This helps both the patient and family to
keep in mind the links between what may be bor-
ing, repetitive or unpleasant daily therapies and
deeply valued goals, such as returning to home
or work.
2
The life goals expressed by the patients may
exposure to other patients with similar condi-
tions.
Many subjects do not appreciate the signi-
cance of various therapies. They fail to link daily
treatment routines to life goals and will not be
motivated to participate in the therapies. These
patients should be made aware that the basic
therapeutic activities are linked to higher order
life goals. The achievement of their life goals
depends on success in attaining the treatment
goals. The patients should be helped to relate
basic, daily treatment routines to their life goals.
Figure 1 Rehabilitation programme based on life goals.
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200
KP Sivaraman Nair
change during the course of a rehabilitation pro-
gramme. This may be due to two reasons. Dur-
ing the initial phases of rehabilitation it may be
difcult to get a true picture of what the patient
wants or is expecting from the team. Impaired
communication and cognitive decits may inter-
fere with the patient’s ability to express life goals.
Neuropsychological interventions may improve
cognitive status. Speech therapy may improve
their ability to communicate. As a result of all
these changes, the rehabilitation team will be
able to obtain a better understanding of the
patient’s goals after he or she has been in the pro-
gramme for a while. The rehabilitation often
results in reduction in disabilities even though the
impairments may not change. The degree of inde-
pendence in activities of daily living and mobil-
ity may become better. These improvements may
result in the patient setting more ambitious goals.
Hence it is important to review the life goals
periodically. At Rivermead Rehabilitation
Centre, life goals are obtained from patients
before each goal-planning meetings. These meet-
ings usually occur once in six weeks.
The role of the rehabilitation team with regard
to patients’ life goals include:
1) Identication of life goals.
2) Analysis of life goals in view of prognosis,
impairments, disabilities, handicap, available
resources and patient’s environment. Decide
whether the goals are achievable or unachiev-
able.
3) Help subjects with unachievable goals to
cope with loss of life goals and develop
attainable goals.
4) Help subjects develop realistic expectations
about rate of progress towards life goals.
5) Plan and implement a rehabilitation pro-
gramme orientated towards patient’s life
goals.
6) Help patients’ to relate treatment goals to life
goals.
7) Periodic reviews to identify changes in life
goals and make suitable changes in the pro-
gramme.
The motivation of the patient to participate in
rehabilitation process may improve with these
steps.
Conclusions
Life goals are hierarchically organized and are
inuenced by various physical and psychological
factors. Illness and disabilities interfere with pur-
suit of life goals. Interruption of life goals results
in emotional distress. Different questionnaires
assess different aspects of life goals. Most of the
currently available life goal questionnaires need
to be tested for validity and reliability in a reha-
bilitation setting. Incorporation of a subject’s life
goals into a management programme results in
better outcomes in various physical and psychi-
atric disorders. It is still not clear whether reha-
bilitation programmes focusing on life goals
make any difference in outcome. Further studies
are required to answer this question.
Acknowledgement
Commonwealth Association of Universities,
London, supported KP Sivaraman Nair during
the period of this study.
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Appendix – Rivermead Life Goals Questionnaire
3
Various aspects and areas of life are given below. I would like you to tell me how important each is to you.
Please rate the importance of each: 0 = of no importance, 1 = of some importance, 2 = of great importance
and 3 = of extreme importance.
1) My residential and domestic arrangements (where I live and who with) are : 0 1 2 3
2) My ability to manage my personal care (dressing, toilet, washing) is : 0 1 2 3
3) My leisure, hobbies and interests including pets are : 0 1 2 3
4) My work, paid or unpaid is : 0 1 2 3
5) My relationship with my partner (or my wish to have one) is : 0 1 2 3
6) My family life (including with those not living at home) is : 0 1 2 3
7) My contacts with friends, neighbours and acquaintances are : 0 1 2 3
8) My religion or life philosophy is : 0 1 2 3
9) My nancial status is : 0 1 2 3
Courtesy of Rivermead Rehabilitation Centre, Abingdon Road, Oxford, UK. Reproduce freely, but
acknowledge source and do not sell.
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