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Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation

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Abstract

Goal setting is considered a key component of rehabilitation for adults with acquired disability, yet there is little consensus regarding the best strategies for undertaking goal setting and in which clinical contexts. It has also been unclear what effect, if any, goal setting has on health outcomes after rehabilitation. To assess the effects of goal setting and strategies to enhance the pursuit of goals (i.e. how goals and progress towards goals are communicated, used, or shared) on improving health outcomes in adults with acquired disability participating in rehabilitation. We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trials registers to December 2013, together with reference checking, citation searching and contact with study authors to identify additional studies. We did not impose any language or date restrictions. Randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs evaluating the effects of goal setting or strategies to enhance goal pursuit in the context of adult rehabilitation for acquired disability. Two authors independently reviewed search results for inclusion. Grey literature searches were conducted and reviewed by a single author. Two authors independently extracted data and assessed risk of bias for included studies. We contacted study authors for additional information. We included 39 studies (27 RCTs, 6 cluster-RCTs, and 6 quasi-RCTs) involving 2846 participants in total. Studies ranged widely regarding clinical context and participants' primary health conditions. The most common health conditions included musculoskeletal disorders, brain injury, chronic pain, mental health conditions, and cardiovascular disease.Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. These studies provide very low quality evidence that including any type of goal setting in the practice of adult rehabilitation is better than no goal setting for health-related quality of life or self-reported emotional status (8 studies; 446 participants; standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.17 to 0.88, indicative of a moderate effect size) and self-efficacy (3 studies; 108 participants; SMD 1.07, 95% CI 0.64 to 1.49, indicative of a moderate to large effect size). The evidence is inconclusive regarding whether goal setting results in improvements in social participation or activity levels, body structure or function, or levels of patient engagement in the rehabilitation process. Insufficient data are available to determine whether or not goal setting is associated with more or fewer adverse events compared to no goal setting.Fourteen studies compared structured goal setting approaches, with or without strategies to enhance goal pursuit, to 'usual care' that may have involved some goal setting but where no structured approach was followed. These studies provide very low quality evidence that more structured goal setting results in higher patient self-efficacy (2 studies; 134 participants; SMD 0.37, 95% CI 0.02 to 0.71, indicative of a small effect size) and low quality evidence for greater satisfaction with service delivery (5 studies; 309 participants; SMD 0.33, 95% CI 0.10 to 0.56, indicative of a small effect size). The evidence was inconclusive regarding whether more structured goal setting approaches result in higher health-related quality of life or self-reported emotional status, social participation, activity levels, or improvements in body structure or function. Three studies in this group reported on adverse events (death, re-hospitalisation, or worsening symptoms), but insufficient data are available to determine whether structured goal setting is associated with more or fewer adverse events than usual care.A moderate degree of heterogeneity was observed in outcomes across all studies, but an insufficient number of studies was available to permit subgroup analysis to explore the reasons for this heterogeneity. The review also considers studies which investigate the effects of different approaches to enhancing goal pursuit, and studies which investigate different structured goal setting approaches. It also reports on secondary outcomes including goal attainment and healthcare utilisation. There is some very low quality evidence that goal setting may improve some outcomes for adults receiving rehabilitation for acquired disability. The best of this evidence appears to favour positive effects for psychosocial outcomes (i.e. health-related quality of life, emotional status, and self-efficacy) rather than physical ones. Due to study limitations, there is considerable uncertainty regarding these effects however, and further research is highly likely to change reported estimates of effect.

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... Goal-setting has been identified as a critical component contributing to engagement in rehabilitation [2,3]. Rehabilitation goals should be intentionally created, have purpose and be developed with the individuals who will be directly affected by the intervention; reflecting client-centered practice [5]. Table 1 outlines some key concepts and definitions related to engagement, client-centered practice, ABI, occupational performance, participation, and goal setting used in this study. ...
... Table 1 outlines some key concepts and definitions related to engagement, client-centered practice, ABI, occupational performance, participation, and goal setting used in this study. There are many different approaches to goal setting and the extent of the client involvement varies [5]. However, goal setting is not always explicit or simple [5]. ...
... There are many different approaches to goal setting and the extent of the client involvement varies [5]. However, goal setting is not always explicit or simple [5]. There are challenges in goal setting processes with individuals with ABI because of possible emotional, communication, and cognitive impairments [3,7,8]. ...
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Purpose To appraise and synthesize evidence from previous systematic reviews (SRs) concerning the impacts of goal setting on engagement in the rehabilitation process and on outcomes of participation and occupational performance for individuals with acquired brain injury (ABI). Materials and methods Systematic review of SRs following the preferred reporting items for SRs and meta-analysis guidelines. Sixteen full text articles were assessed for eligibility, from which four were included in the review. The Critical Appraisal Skills Programme checklists for SRs was used to rate quality and risk of bias. Results Four SRs of moderate to high quality included a variety of methodologies. Evidence of moderate quality showed clients’ active participation in goal setting had positive impacts on the client and their engagement in the process. Findings suggested that goal-directed interventions, particularly in outpatient rehabilitation, may improve occupational performance. There was some indication that goal setting may support adherence to therapeutic exercises, but relevance to rehabilitation outcomes was less clear. Findings related to participation outcomes were minimal. Conclusions Goal setting is a complex and multidimensional process. Goal setting may contribute to improved engagement in rehabilitation although few studies explored occupational performance and participation outcomes for individuals with ABI. • Implications for rehabilitation • Active goal setting may contribute to improved engagement in rehabilitation, however, including individual clients in the goal setting process requires creativity and flexibility on behalf of professionals. • A model is presented to promote understanding of the personal and environmental barriers and facilitators that may interact with goal setting approaches to promote engagement in rehabilitation. • There is a need for more research exploring impact of active client-centered goal setting on occupational performance and participation outcomes for people with acquired brain injury.
... Goal setting and tracking in therapeutic settings is grounded in motivation theory [7][8][9] such that working towards goals is a continuous feedback loop which builds on self-efficacy, self-determination and motivation to continue to strive towards goals, acting as a selfregulation strategy [10,11]. Goal setting may be more feasible or acceptable to individuals with particular personality traits e.g., individuals who attribute successes and failures to external factors are less likely to find meaning in striving towards goals than those who attribute successes and failures to their own actions [12]. ...
... This study aimed to provide a synthesis of existing literature, identifying knowledge gaps. Whilst much may be drawn from related research, caution must be exercised when translating findings into other contexts [11], and whilst promising, generalising adult findings to youth must be exercised with an abundance of caution. Evidence suggests that adults and children think differently; as children grow, their cognitive processes develop, and their contexts and perspectives change, impacting on understandings of the self and the world around them. ...
... Whilst support approaches that incorporate structured goal setting are often characterised by a greater emphasis on client-centredness, the links between personally meaningful outcomes and the specific behaviour change techniques required to progress towards goals are not clear. Further, the person-centred focus is hypothesised as a conduit to positive ratings of self-efficacy, quality of life and service satisfaction, but evidence is lacking [11]. Whilst previous literature from within the youth mental health field suggests that working on goals is motivating and increases self-efficacy [34,42], evidence is still limited. ...
Article
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Background Goal setting and goal-focused work is widely used in young people’s mental health settings. However, little is known about how, why or for whom this is helpful. This study aims to explore the mechanisms of collaborative goal setting as part of therapeutic relationships: is it helpful for young people experiencing anxiety and/or depression, how and why/not, for whom, and under what circumstances? Methods Online database searches generated 10,907 records. Seven unique studies are included, combined with insight analysis from directed discussions with international advisors with lived experience of anxiety and/or depression and therapy (N = 8; mean age = 20.8), and mental health academics/clinicians (N = 6). Results Findings are presented as a narrative synthesis and suggest that goal setting is helpful to young people experiencing anxiety and/or depression because it helps build good therapeutic relationships through open communication and building trust. Goal setting helps make things more manageable, enabling young people to feel supported and have ownership of their care. Individual preferences, or high levels of distress, trauma, low confidence, hopelessness, negative past experiences of goal setting, perfectionism, and rumination are considered limiting factors to goal setting. Additionally, contextual factors including country and long-term therapy are explored. Conclusion Whilst the resultant sample is small, emphasis on the voices of young people in the research is both prominent and of paramount importance. Several key literature gaps are identified, including evidenced links to the reduction in symptoms. Priority must be given to researching unhelpful mechanisms of goal setting for young people experiencing anxiety and/or depression, to avoid any potential iatrogenic effects.
... 1 2 Goal planning has an important role in the rehabilitation of adults with a disability (eg, following brain injury, mental illness or muscular injuries). 3 Goal planning within healthcare and rehabilitation settings has been found to have a positive effect on health-related quality of life, selfreported emotional status and service user self-efficacy. 3 A number of psychological theories underpin the process of goal planning and describe how setting goals allows people to monitor, alter or adapt their behaviour. 4 Social cognitive theory 5 emphasises the influence of self-efficacy on an individual's motivation to set and achieve goals, while health action theory 6 highlights the phases involved in goal planning and achievement. ...
... 3 Goal planning within healthcare and rehabilitation settings has been found to have a positive effect on health-related quality of life, selfreported emotional status and service user self-efficacy. 3 A number of psychological theories underpin the process of goal planning and describe how setting goals allows people to monitor, alter or adapt their behaviour. 4 Social cognitive theory 5 emphasises the influence of self-efficacy on an individual's motivation to set and achieve goals, while health action theory 6 highlights the phases involved in goal planning and achievement. ...
... 8 How goals are used in healthcare and rehabilitation settings is not always clearly defined and a range of terminology and approaches to goal planning have been described within the literature. 3 For the purpose of this review, the term goal planning will be used as it is commonly used in mental health recovery literature, encompassing other terms including goals, goal setting and goal attainment. To support positive outcomes, it is generally agreed that goals should be collaboratively developed, relevant to the person concerned, challenging but realistic and achievable, and include a component of measurability. ...
Article
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Introduction Goal planning is widely recognised as an integral part of mental health service delivery and an important element in supporting recovery. Goal planning identifies priorities for treatment through discussion and negotiation between service users and health practitioners. Goal planning enhances motivation, directs effort, and focuses the development of strategies and treatment options to improve recovery outcomes and promote service users’ ownership of the recovery process. While goal planning is a common practice in mental health settings, evidence regarding its impact on treatment outcomes is lacking. This paper outlines a protocol for a systematic review that aims to explore the types of goals planned, experiences of service users and practitioners, and the effectiveness of goal planning as a mental health intervention. Methods and analysis A systematic search will be conducted during March 2021 by searching Medline, CINAHL, Embase, Scopus and PsycINFO electronic databases to answer the following questions: (1) What types of goals are being developed within mental healthcare?; (2) What is the evidence for the effectiveness of goal planning on health and well-being for mental health service users?; (3) What are the experiences of mental health service users and their treating healthcare practitioners in relation to goal planning?; and (4) What are the barriers and facilitators to effective goal planning in mental health settings? Two independent researchers will screen the articles, selecting literature that meets criteria. All literature, regardless of study design that involves adult participants, with a mental illness and reporting on goal planning will be considered for inclusion. Data will be extracted from all eligible articles regardless of study design and summarised in a table. Appropriate quality assessment and data synthesis methods will be determined based on included study designs. Ethics and dissemination No ethics approval is required. The results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO registration number CRD42020220595.
... Background Goal setting is a key part of the rehabilitation process [1] and is ultimately geared toward helping patients make functional progress in their recovery [2]. Rehabilitation goals have been defined as "a desired future state to be achieved by a person with a disability as a result of rehabilitation activities" [1]. ...
... Background Goal setting is a key part of the rehabilitation process [1] and is ultimately geared toward helping patients make functional progress in their recovery [2]. Rehabilitation goals have been defined as "a desired future state to be achieved by a person with a disability as a result of rehabilitation activities" [1]. Rehabilitation goals are "actively selected, intentionally created, have a purpose, and are shared-where possible-by the people participating in the activities and interventions designed to address the consequence of acquired disability" [1]. ...
... Rehabilitation goals have been defined as "a desired future state to be achieved by a person with a disability as a result of rehabilitation activities" [1]. Rehabilitation goals are "actively selected, intentionally created, have a purpose, and are shared-where possible-by the people participating in the activities and interventions designed to address the consequence of acquired disability" [1]. Goal setting has face validity as a method to enhance communication and collaboration within rehabilitation teams and may result in improved patient-reported quality of life after rehabilitation [1]. ...
Article
Background Goal setting is a key part of the rehabilitation process. The use of technology and electronic tools such as smartphone apps and websites has been suggested as a way of improving the engagement of users in meaningful goal setting and facilitating shared decision-making between patients and health professionals. Objective This study aims to describe experiences of health professionals and patients in the use of the English language version of the iPad app Aid for Decision-making in Occupational Choice (ADOC) to facilitate collaborative goal setting in rehabilitation. Methods We recruited participants from 3 acute and postacute care rehabilitation wards in both public and private organizations in New Zealand. Participants were registered allied health professionals, including physiotherapists, occupational therapists, and speech-language therapists, who engage in goal setting as part of their normal work, and their adult patients. We collected data via semistructured interviews to gather information about the experiences of the participants in the use of ADOC for goal setting. Data were analyzed with thematic analysis. Results A total of 8 health professionals and 8 patients participated in the study. Six main themes emerged from the data: changing patients’ perspective on what is possible, changing health professionals’ perspective on what is important, facilitating shared decision-making, lack of guides for users, logistic and organizational barriers, and app-related and technical issues. Conclusions Health professionals and patients found ADOC to be a valuable tool when setting shared rehabilitation goals. The use of ADOC promoted a patient-centered approach that empowered patients to engage in collaborative goal setting. The technological limitations of the app that negatively impacted experiences can be addressed in the future implementation of ADOC in rehabilitation settings.
... (Rosewilliam et al. 2011;Sugavanam et al. 2013). Currently only low-to-moderate evidence on effectiveness of goal setting and evaluation practice on psychosocial factors (HR-QoL, emotional status and self-efficacy) is available (Levack et al. 2015). ...
... Standardized measurement tools support and inform clinical decision-making and communication with others (Tyson et al. 2010;Rosewilliam et al. 2011;Brown et al. 2013;Plant et al. 2016). Also, feedback on progresses to patients and relatives are much more likely to be understood if standardized assessments are used (Tyson et al. 2014b;Levack et al. 2015). To enhance comparability of health information collected in different settings, linking rules are available to serve as a basis for evidence-based decision-making across all levels of health systems (Cieza et al. , 2016. ...
... In a Cochrane review on goal setting and strategies to enhance goal pursuit in neurorehabilitation, Levack et al. (2015) found 39 studies published before December 2013, involving a total of 2846 participants receiving rehabilitation in a variety of countries and clinical situations. They identified at least 12 different approaches to goal setting with a lot of variations regarding goal identification, selection, prioritizing, goal characteristics, the use for intervention planning, etc. ...
Chapter
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Stroke-associated impairments display a wide variety of clinical signs and symptoms. Therefore, a multidisciplinary team with different experts working closely together is necessary for effective stroke rehabilitation. In rehabilitation of stroke patients, a holistic view on functioning and disability is necessary to establish an individualized and comprehensive treatment program. The WHO International Classification of Functioning, Disability and Health (ICF) provides a common language to describe individual functioning in a given context suitable for a shared documentation system. Goal setting has become a central component of effective communication and decision-making in rehabilitation practice, both as part of the process and as a person-centred outcome measure for stroke rehabilitation. Nevertheless, agreed standards on goal setting and evaluation still need to be defined. Here, we highlight some aspects with relevance for multidisciplinary team building and coordination and for using the ICF in the context of stroke rehabilitation; how to describe individual levels of functioning and disability and to set treatment goals as well as to identify barriers and facilitators to individual functioning and health.
... Goal setting refers to the process in which rehabilitation goals are identified and agreed between the medical team and the patient (Austin & Vancouver, 1996). Goal setting is considered a core practice of clinical rehabilitation (Levack et al., 2015). Goals within the context of rehabilitation have a twofold definition (Wade, 2009). ...
... Rehabilitation goals are actively selected, are intentionally created and have a very specific purpose. Besides the establishment of rehabilitation goals, additional goal-related activities among which the development of a strategy to achieve the stated rehabilitation goals, monitoring treatment progress, providing feedback and compliance with treatment goals indicate how successful patients will be in achieving their goals (Levack et al., 2015). ...
Article
Background Chronic pain is a major healthcare issue that often requires an interdisciplinary treatment approach. Defining relevant treatment goals is one of the crucial steps in creating successful rehabilitation schemes. Therefore, the first aim is to explore goals that patients suffering from chronic pain aim to achieve. The second aim is to translate those goals into measurable functional outcome variables which can be used to measure treatment success. Methods An online survey was developed and spread through local pain alliances in six European countries. Participants, patients suffering from chronic pain, were asked to report their most important goals, combined with a rank to denote the importance of each goal. For the highest ranked goals, participants were asked to decompose their goal into functional postures and the number of minutes per posture to achieve this goal. Results We approached 1494 persons, of which 487 effectively completed this survey. The highest ranked goals were taking part in family and social activities (72.55%), pain reduction (91.18%) and household tasks (68.14%). Obtaining pain reduction was most often ranked first (55.75%), followed by improving sleep (12.25%) and taking part in family or social activities (11.00%). For all goals, walking was a crucial component. Conclusions Goals of chronic pain patients are in line with previously explored expectations, denoting the importance of achieving pain relief combined with improvements on the level of activities and participation. This survey indicates that rehabilitation programs should definitely focus on improving walking ability, due to its importance in underpinning overall goal achievement.
... The identification of a person's goals and wishes is believed to be a key element and crucial for the success of rehabilitation interventions. [1][2][3] Goals should reflect the perspective of the persons living with the disability. Goal-setting needs to be conducted in close collaboration between the individual and the health professionals as a basis for individually tailored rehabilitation interventions. ...
... [4][5][6] Advantages of patient involvement in goal-setting are increased patient motivation, patient satisfaction and greater achievement of goals. 2,[7][8][9][10] Insufficient implementation of personally valuable goals is known to be a reason for dissatisfaction with rehabilitation, and capturing the patients' concerns and perspectives is essential for goal achievement. 6,11 When setting goals for a treatment period, health professionals have to capture the content of the patients' individual goals while also guiding the process and setting meaningful goals for both the patients and the health professionals. ...
Article
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Purpose: To explore the goal-setting process carried out at a rehabilitation facility providing adapted physical activity, by 1) identifying goals set by individuals with chronic disabilities, 2) comparing these goals to the negotiated goals set in collaboration with the rehabilitation team and 3) assessing goal achievement and its association with self-reported functioning after 12 months. Methods: A prospective observational study where adults (18-67 years) admitted to Beitostølen Healthsports Centre (n=151) reported mental and physical functioning measured by the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) administered at baseline (eight weeks before rehabilitation), admission, discharge and follow-up 12 months after rehabilitation. The participants provided their individual goals for rehabilitation in the admission questionnaire. Individual goals were compared to negotiated goals set by the participants and the rehabilitation team together as part of the goal-setting process at the facility. The goals were linked to The International Classification of Functioning, Disability and Health (ICF) for comparison. Goal achievement was assessed on a 10-point numeric rating scale (NRS) in the discharge questionnaire. The association between SF-12 physical and mental functioning at long-term follow-up and goal achievement was explored. Results: The 293 individual goals and the 407 negotiated goals were most frequently linked to the ICF-component Body Functions. When comparing negotiated to individual goals, negotiated goals were more frequently linked to activities and participation. Goals to wide to be linked to the ICF were less frequent. For 76% of the participants, content of individual goals was captured in negotiated goals. Goal achievement with NRS scores ≥9 points was reported by 66% of the included participants. Goal achievement was a significant predictor for long-term mental functioning (p=0.04). Conclusion: Collaboration between participants and health professionals resulted in more specific goals directed towards the activities and participation component. Goal achievement predicted long-term mental functioning following rehabilitation.
... Collaborative goal setting (6,11,12) and action plans (11) have been mentioned as key measures in person-centered rehabilitation. There is an extensive literature on goals and goal setting in rheumatic rehabilitation (12)(13)(14)(15)(16) as well as in rehabilitation in general (11,17). Collaborative goal setting may have positive effects on psychosocial outcomes (17). ...
... There is an extensive literature on goals and goal setting in rheumatic rehabilitation (12)(13)(14)(15)(16) as well as in rehabilitation in general (11,17). Collaborative goal setting may have positive effects on psychosocial outcomes (17). Moreover, goals and accompanying action plans are expected to facilitate adherence to treatment plans and support a healthy lifestyle after discharge (11,12,14,15,(18)(19)(20). In clinical rheumatology research, there is an increasing focus on post discharge support and how to extend the duration of the individual rehabilitation process after discharge (14,15,(18)(19)(20) and establish new routines (15). ...
Article
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Background Person-centeredness is increasingly addressed in relation to rehabilitation interventions. Collaborative goal setting and action plans are key measures in person-centered rehabilitation. There is a lack of knowledge about how person-centered goals and action plans developed away from the patient's everyday life are experienced by patients after discharge. Purpose This aim of the study is to explore how patients with rheumatic diseases experience the relevance of goals and action plans after discharge from inpatient rehabilitation hospital stay. Methods Individual narrative interviews were conducted with eight patients with rheumatic diseases, aged between 40 and 60. A convenience sampling strategy was applied. Data collection, analysis and interpretation of data were performed within a phenomenological-hermeneutic framework inspired by Paul Ricoeur's interpretative philosophy. Results The analysis derived one core theme, “The relevance of goals and action plans is contextual” and three subthemes: “Admission—a protected bubble,” “Back home—a harsh reality,” and “Need for post-discharge support.” Conclusion This study indicates that the relevance of goals and action plans to patients with rheumatic diseases is context specific. On the basis of the study, it is suggested that the context should be considered in rehabilitation practice, including the social network of the patients. This is in order to support patients in rehabilitation interventions to manage everyday life with disease after discharge to their own homes. Moreover, the concept of context in person-centered rehabilitation should be reconsidered. The study also concludes that there is a need for further development and research in follow up programs, as it is not clear what may constitute an optimal design of follow up support.
... Common factors included the lengthy rehabilitation process, competing life demands, time commitment, rising costs, setbacks, or plateaus in rehabilitation. As self-motivation has been linked to home exercise completion (5), ongoing support is crucial to educate patients on the importance of completing rehabilitation and utilising goal setting to foster self-e cacy in rehabilitation (19). Further external motivation can be gained by drawing from the success of others who have returned to sport, such as professional athletes. ...
... Paired with effective coaching utilising clear non-technical instructions and external focused cues, it will improve independent technical pro ciency, exercise understanding, and adherence. While evidence for goal setting improving physical and psychosocial outcomes after musculoskeletal injury is of low quality at present, participants reported it as a valuable strategy during their care (19). Combining appropriate exercise delivery and goal setting with regular communication and supportive information also provides a valuable opportunity to enhance the therapeutic relationship, which is positively correlated with patient outcomes (35). ...
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Background Current evidence demonstrates that few patients complete anterior cruciate ligament reconstruction rehabilitation according to evidence-based guidelines. It is important to investigate the viewpoints of our patients to identify patient-reported barriers and facilitators of anterior cruciate ligament reconstruction rehabilitation. Qualitative analysis can provide insight into potential methods for improving the delivery of rehabilitation services. Methods In this qualitative study, utilising a social constructionism orientation, viewed through the social phenomenological lens, three focus groups were conducted with individuals 1–20 years post anterior cruciate ligament reconstruction (n = 20, 9 males, 11 females, mean 6.5 years post-surgery, 21–51 years old). Focus groups were recorded, transcribed, and coded using an inductive semantic thematic analysis methodology. Participants were asked about their experiences during anterior cruciate ligament reconstruction rehabilitation. Results Five organising themes were identified (consisting of 19 sub-themes) to provide a framework to present the data: psychological, physiological, rehabilitation service, rehabilitation characteristics, and interaction with others. Each theme details aspects of rehabilitation, such as exercise delivery, informational support, frequency, and duration of care, kinesiophobia, weight gain and interactions with teams and coaches, which present barriers for patients to adhere to and participate in rehabilitation. Example quotes are provided for each theme to provide context and the patient’s voice. Conclusions This qualitative investigation identified key aspects of a patient's rehabilitation in which they encounter a variety of barriers and facilitators of ACL reconstruction rehabilitation. This cohort consistently identified these aspects as areas that affected their rehabilitation. The themes may provide targets for clinicians to improve rehabilitation and deliver patient-centred care. However, the themes must evaluate in future trials to assess whether interventions to remove barriers or enhance facilitators improves subsequent outcomes such as return to sport and re-injury rates.
... Common factors included the lengthy rehabilitation process, competing life demands, time commitment, rising costs, setbacks, or plateaus in rehabilitation. As self-motivation has been linked to home exercise completion [5], ongoing support is crucial to educate patients on the importance of completing rehabilitation and utilising goal setting to foster self-efficacy in rehabilitation [19]. Further external motivation can be gained by drawing from the success of others who have returned to sport, such as professional athletes. ...
... Paired with effective coaching utilising clear non-technical instructions and external focused cues, it will improve independent technical proficiency, exercise understanding, and adherence. While evidence for goal setting improving physical and psychosocial outcomes after musculoskeletal injury is of low quality at present, participants reported it as a valuable strategy during their care [19]. Combining appropriate exercise delivery and goal setting with regular communication and supportive information also provides a valuable opportunity to enhance the therapeutic relationship, which is positively correlated with patient outcomes [35]. ...
Article
Full-text available
Background Current evidence demonstrates that few patients complete anterior cruciate ligament reconstruction rehabilitation according to evidence-based guidelines. It is important to investigate the viewpoints of our patients to identify patient-reported barriers and facilitators of anterior cruciate ligament reconstruction rehabilitation. Qualitative analysis can provide insight into potential methods for improving the delivery of rehabilitation services. Methods In this qualitative study, utilising a social constructionism orientation, viewed through the social phenomenological lens, three focus groups were conducted with individuals 1–20 years post anterior cruciate ligament reconstruction (n = 20, 9 males, 11 females, mean 6.5 years post-surgery, 19–51 years old). Utilising a semi-structured interview guide, participants were asked about their experiences during anterior cruciate ligament reconstruction rehabilitation. Focus groups were recorded, transcribed, and coded using an inductive semantic thematic analysis methodology. Results Five organising themes were identified (consisting of 19 sub-themes) to provide a framework to present the data: psychological, physiological, rehabilitation service, rehabilitation characteristics, and interaction with others. Each theme details aspects of rehabilitation, such as exercise delivery, informational support, frequency, and duration of care, kinesiophobia, weight management and interactions with teams and coaches, which present barriers or facilitators for patients to adhere to and participate in rehabilitation. Example quotes are provided for each theme to provide context and the patient’s voice. Conclusions This qualitative investigation identified key aspects of a patient's rehabilitation in which they encounter a variety of barriers and facilitators of ACL reconstruction rehabilitation. These aspects, such as the rehabilitation characteristics, service delivery, psychological and physiological factors, and interactions with others, were consistently identified by this cohort as factors which affected their rehabilitation. The themes may provide targets for clinicians to improve rehabilitation and deliver patient-centred care. However, the themes must be evaluated in future trials to assess whether interventions to remove barriers or enhance facilitators improves subsequent outcomes such as return to sport and re-injury rates.
... The Australian Faculty of Rehabilitation Medicine (AFRM) recommend that "the patient and the rehabilitation team work together to establish meaningful and achievable treatment goals" in rehabilitation services [1] (p.6). Goal-setting has been defined as the establishment or negotiation of rehabilitation goals [2] and is recognized as a complex process that has the potential to enhance client outcomes and autonomy [3]. The Medical Research Council (MRC) highlight that to understand how a complex intervention works, one must first identify the 'active ingredients' [4]. ...
... At the centre of the KTA framework, lies the development and synthesis of knowledge. Several systematic reviews on goal-setting in rehabilitation have already been published [2,8,[24][25][26]. Moving Keywords: Behaviour change, Co-production, Decision-making Shared, Goals, Implementation Science, Intervention design, Occupational Therapy, Physical Therapists, Stroke Rehabilitation, User centred design to the seconds stage of the KTA framework the first study in this program of research used medical record audits and client interviews to highlight evidence practice gaps in goal-setting practices across varied case mix rehabilitation services in Queensland [11]. ...
Article
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Background Several active ingredients contribute to the purposes and mechanisms of goal-setting in rehabilitation. Active ingredients in the goal-setting process include, interdisciplinary teamworking, shared decision-making, having meaningful and specific goals, and including action planning, coping planning, feedback, and review. Clinicians have expressed barriers and enablers to implementing these active ingredients in rehabilitation teams. Interventions designed to improve goal-setting practices need to be tailored to address context specific barriers and enablers. Attempts to understand and enhance goal-setting practices in rehabilitation settings should be supported using theory, process models and determinant frameworks. Few studies have been undertaken to enhance goal-setting practices in varied case-mix rehabilitation settings. Methods This study is part of a larger program of research guided by the Knowledge to Action (KTA) framework. A multisite, participatory, codesign approach was used in five sites to address three stages of the KTA. (1) Focus groups were conducted to understand barriers and enablers to implementing goal-setting at each site. Following the focus groups three staff co-design workshops and one consumer workshop were run at each site to (2) adapt knowledge to local context, and to (3) select and tailor interventions to improve goal-setting practices. Focus groups were analysed using the Theoretical Domains Framework (TDF) and informed the selection of behaviour change techniques incorporated into the implementation plan. Results Barriers and enablers identified in this study were consistent with previous research. Clinicians lacked knowledge and understanding of the differences between a goal and an action plan often confusing both terms. Clinicians were unable to demonstrate an understanding of the importance of comprehensive action planning and review processes that extended beyond initial goal-setting. Interventions developed across the sites included staff training modules, a client held workbook, educational rehabilitation service flyers, interdisciplinary goal-based case conference templates, communication goal boards and a key worker model. Implementation plans were specifically established for each site. Conclusions Rehabilitation teams continue to struggle to incorporate a truly client-centred, interdisciplinary model of goal-setting in rehabilitation. Whilst clinicians continue to lack understanding of how they can use aspects of goal-setting to enhance client outcomes and autonomy in rehabilitation settings.
... Adams 1999) und die Einsicht in Grenzen der Funktionswiederherstellung sowie die Bewältigung derselben fördern (Playford et al. 2009). Ein Cochrane-Review aus dem Jahr 2015 beschreibt einen moderaten Vorteil eines strukturierten Zielsetzungsprozesses auf die gesundheitsbezogene Lebensqualität und den emotionalen Zustand gegenüber dem Fehlen eines Zielsetzungsverfahrens (Levack et al. 2015). Ein weiteres Review belegt die positiven Effekte von Zielvereinbarungen im Hinblick auf Leistungsverbesserungen, und einen positiven Einfluss auf die Selbstwirksamkeit (s. ...
... Trotz einer Reihe von Studien zu unterschiedlichen Aspekten von Zielen in der Neurorehabilitation bleiben viele Fragen noch immer unbeantwortet (Levack et al. 2015): Führt ein stärkeres Einbinden der Betroffenen und/ oder der Bezugspersonen in den Zielsetzungsprozess tatsächlich zu einem besseren Ergebnis? Führen Ziele, die auf der Handlungsebene (Aktivitäten/ Partizipation) angesiedelt sind, zu einem besseren Ergebnis als Ziele auf der Ebene der Körperfunktionen? ...
... We were unable to identify any randomised trials that tested the efficacy of goal setting alone in this population. A Cochrane Review (Levack et al., 2015) found low quality evidence for the effect of goal setting to improve outcomes for persons with acquired disabilities. However, the evidence suggests there may be some positive psychosocial outcomes such as improved self-efficacy (Levack et al., 2015). ...
... A Cochrane Review (Levack et al., 2015) found low quality evidence for the effect of goal setting to improve outcomes for persons with acquired disabilities. However, the evidence suggests there may be some positive psychosocial outcomes such as improved self-efficacy (Levack et al., 2015). Despite this, most people acknowledge that goal setting is beneficial, and therefore, conducting a randomised controlled trial where some participants are unable to set goals for their rehabilitation presents ethical challenges. ...
Article
Introduction: Goal setting is an integral part of the rehabilitation process and assists occupational therapists to target therapy towards achieving meaningful outcomes. People with mild cognitive impairment or dementia may experience barriers participating in goal setting due to preconceptions that the person cannot participate owing to changes in both cognitive and communicative abilities. The aim of this review was to identify goal setting approaches, common goals identified, and enablers and barriers to goal setting for people with mild cognitive impairment or dementia participating in specific rehabilitation programmes. Methods: Four electronic databases were searched in April 2020 for English language articles that described goal setting processes during a rehabilitation programme for people with mild cognitive impairment or dementia. Studies of all designs were included. Two authors screened citations and full text articles. Data were extracted, synthesised, and presented narratively. Results: Twenty-seven studies met the eligibility criteria. Both structured and nonstructured goal setting methods were used with common tools including the Canadian Occupational Performance Measure, the Bangor Goal Setting Interview and Goal Attainment Scaling. The nature of goals tended to depend on the scope of the rehabilitation programme in which the person was involved. Goal setting was more difficult for people with more advanced symptoms of dementia and when staff lacked skills and experience working with people with dementia. Use of a structured approach to goal setting, establishment of therapeutic rapport, individualisation of goals, and family involvement were reported to be beneficial. Conclusion: Collaborative goal setting is a foundation of rehabilitation for people with dementia and should not be avoided due to preconceptions that the person cannot participate. Results suggests that occupational therapists can use a number of strategies to maximise participation and engagement and play a pivotal role in upskilling staff to enable effective goal setting for people with mild cognitive impairment or dementia.
... The two main findings were that young people and their families have varying experiences of the goal setting process and that the young person, parents, and professionals all play a unique role; and the therapeutic relationship enables young people and their parents to engage with professionals so they can become active collaborators in developing rehabilitation goals. These findings broadly align with previous research exploring goal setting in rehabilitation from the perspective of adults with ABI and their carers (Levack et al., 2015;Sugavanam et al., 2013) and parents of children with CP (Pritchard- Wiart & Phelan, 2018). ...
Article
This study explored the experiences of goal setting in paediatric rehabilitation from the perspectives of children and adolescents with acquired brain injury (ABI) and their parents in paediatric rehabilitation. Using a qualitative research design, 15 semi-structured interviews were conducted with 13 parents and 8 young people with ABI aged between 9 and 18 years who were engaged in outpatient rehabilitation. Interview transcripts were analysed using constructivist grounded theory methods. Two main themes and several sub-themes emerged: Experiences of goal setting: The role of professionals; The role of the young person; and The role of the parents. Working as a team: Understanding each other and building trust; Communicating, sharing knowledge and different perspectives; and Being flexible. These themes reflect parent’s and young people’s experience of goal setting during paediatric rehabilitation for ABI and suggest clinicians play an important role in educating young people and their families about goal setting in the outpatient rehabilitation context. Young people and their parents also perceive the focus of outpatient rehabilitation as working collaboratively with clinicians to gain knowledge to manage the consequences of ABI. Our findings emphasize the importance of the therapeutic consumer–clinician relationship and the need to actively engage young people in goal setting.
... Although goal setting is regularly used in rehab settings, a Cochrane review found there is very low-quality evidence that goal setting may improve some outcomes (Levack et al., 2015). A pledge, however, does not have an endpoint and is something we are working on constantly. ...
Thesis
Changes in movement quality, specifically how people coordinate movement, have been identified in people with pain, history of pain and linked to risk of injury, changes in performance and quality of life. The health of movement is a balance between how an individual uses their body to engage with life and an ability to display choices in movement coordination strategies (MCS). The aim of this thesis is to explore the concept that assessing and retraining MCS improves the health of movement. Five core publications are included: two theoretical papers detailing the concept for assessing and retraining MCS; one reliability study establishing robustness of an assessment tool; a case report demonstrating validity and proof-of-concept of assessment and retaining of MCS; and a morphological study of the serratus anterior muscle illustrating knowledge of anatomical architecture can shape retraining strategies. The commentary includes the following topics: i) theoretical concept for assessing and restoring the health of movement (Chapter 2); ii) aspects of anatomy and neurophysiological function to support methods of assessment and retraining (Chapter 3); iii) assessment of loss of movement choices (LMC) using cognitive movement control tests to inform retraining (Chapter 4); iv) cognitive movement retraining/movement coaching, a person-centred clinical reasoning framework to design individual tailored programmes to restore LMC (Chapter 5); v) General discussion - significance, implementation and impact, illustrated over 25 years (Chapter 6). Results have demonstrated: i) good inter-rater and excellent intra-rater reliability for the assessment tool; ii) testing for LMC can inform retraining and cognitive movement retraining can change biomechanical and neurophysiological measures; and iii) novel findings of morphologically distinct subdivisions of serratus anterior. This thesis recommends the assessment of MCS to guide retraining to improve the health of movement. Theoretical concepts presented and research conducted have provided evidence for proof-of-concept and validity and reliability of assessment procedures<br/
... We observed that participants who were able to formulate personal rehabilitation goals were motivated to achieve progress in rehabilitation. Goal setting is essential in rehabilitation as it helps to evaluate the rehabilitation progress and is associated with increased patient motivation and satisfaction with care delivery [37][38][39]. Therefore, more attention on goal setting and recognition of apathy in frail older cardiac patients may be needed in the education of physical therapists for home-based CR. ...
Article
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Background Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients’ participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. Methods A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. Results Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants’ recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. Conclusion Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients’ needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.
... Goal setting means one's selection of goals [19] to pursue, and that one pursues what one wishes to [20]. Researchers have tried to distinguish between different types of goals. ...
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Background: The self-determination of people with an intellectual disability (ID) in the contexts of adulthood and Chinese culture is under-examined in the field of ID, even though the concept of self-determination has vigorously developed in recent decades. This study examined the relationship between self-determination competencies and the personal well-being of adults with mild ID in Hong Kong, as well as their personal goals and decision-making (dis)agreements with their significant others. Methods: We interviewed 170 participants using the AIR Self-Determination Scale-Chinese Version (AIR SDS-C) and the Personal Well-Being-Intellectual Disability (Cantonese) (PWI-C), along with a self-constructed questionnaire. Results: When the demographic characteristics were controlled, self-determination competencies correlated positively with personal well-being (r = 0.313, p < 0.001), diverse personal goals were identified, and agreement with significant others was dominant in both daily and major decision-making. Conclusions: A positive correlation between self-determination and personal well-being was confirmed in a Chinese population with mild ID. These findings expand the understanding of the types of personal goals and agreement patterns of people with mild ID and yield implications for further research and practices.
... The use of goal attainment OM were mentioned in all three CAULIN sources, although no specific OM could be identified. Remarkably, a Cochrane review reported that only 3 out of 39 studies, investigating the effect of goal-setting on psychosocial outcomes during rehabilitation of people with acquired disability, used a goal attainment evaluation [30]. Goal Attainment Scaling was the only OM used in those studies. ...
Article
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Background Technology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabilitation of neurological conditions, but use in clinical practice remains limited. Agreement on a core set of reliable, valid and accessible outcome measures to assess rehabilitation outcomes is needed to generate strong evidence about effectiveness of rehabilitation approaches, including technologies. This paper collates and synthesizes a core set from multiple sources; combining existing evidence, clinical practice guidelines and expert consensus into European recommendations for Clinical Assessment of Upper Limb In Neurorehabilitation (CAULIN). Methods Data from systematic reviews, clinical practice guidelines and expert consensus (Delphi methodology) were systematically extracted and synthesized using strength of evidence rating criteria, in addition to recommendations on assessment procedures. Three sets were defined: a core set : strong evidence for validity, reliability, responsiveness and clinical utility AND recommended by at least two sources; an extended set : strong evidence OR recommended by at least two sources and a supplementary set : some evidence OR recommended by at least one of the sources. Results In total, 12 measures (with primary focus on stroke) were included, encompassing body function and activity level of the International Classification of Functioning and Health. The core set recommended for clinical practice and research: Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT); the extended set recommended for clinical practice and/or clinical research: kinematic measures, Box and Block Test (BBT), Chedoke Arm Hand Activity Inventory (CAHAI), Wolf Motor Function Test (WMFT), Nine Hole Peg Test (NHPT) and ABILHAND; the supplementary set recommended for research or specific occasions: Motricity Index (MI); Chedoke-McMaster Stroke Assessment (CMSA), Stroke Rehabilitation Assessment Movement (STREAM), Frenchay Arm Test (FAT), Motor Assessment Scale (MAS) and body-worn movement sensors. Assessments should be conducted at pre-defined regular intervals by trained personnel. Global measures should be applied within 24 h of hospital admission and upper limb specific measures within 1 week. Conclusions The CAULIN recommendations for outcome measures and assessment procedures provide a clear, simple, evidence-based three-level structure for upper limb assessment in neurological rehabilitation. Widespread adoption and sustained use will improve quality of clinical practice and facilitate meta-analysis, critical for the advancement of technology-supported neurorehabilitation.
... Goal setting can help patients progress toward desired treatment outcomes relating to behavioral changes and can also improve engagement with healthcare providers [16][17][18]. Goal setting and defining treatment success as goal achievement are integral to cognitive behavioral therapy (CBT) and to the application of the GAS adapted for depression (GAS-D) approach for patients with MDD. Both approaches involve identifying a behavior associated with the symptoms of MDD and setting goals representing a desirable behavior change. ...
Article
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Background Major depressive disorder (MDD) is the leading cause of disability worldwide. Response to pharmacologic treatment is generally evaluated by traditional clinician- and patient-reported rating scales. Assessing therapeutic efficacy using the Goal Attainment Scale offers a complementary measure that focuses on recovery-oriented outcomes that patients consider valuable and vital to their well-being. This study aimed to examine outcomes using the Goal Attainment Scale adapted for depression (GAS-D). Methods A phase 4, single-arm, open-label, multicenter study enrolled patients with MDD who were switching antidepressant medication. Patients received vortioxetine 10–20 mg over 12 weeks. Three specific, measurable, attainable, relevant, and time-bound goals were collaboratively set by patients with their clinicians. One goal was determined by the patient’s self-defined objectives; 2 were related to predefined domain categories. Prespecified domains included psychological, motivational, emotional, physical/functional, and cognitive categories. The primary endpoint was the proportion of patients who achieved a GAS-D score ≥ 50 at week 12. Secondary and exploratory endpoints included changes from baseline in several clinical and patient-reported measures of depression and cognitive function. Safety and tolerability were also assessed. Results At week 12, of the 122 adults participating in the study, 57.8% achieved a GAS-D score ≥ 50. Depression severity, cognitive function, cognitive performance, well-being, employment, and quality of life also significantly improved. Treatment response and remission rates were 65 and 40%, respectively. Vortioxetine was well tolerated, with adverse events consistent with product labeling. Conclusions A majority of patients with MDD switching to vortioxetine achieved their treatment goals, including improvement in specific functional outcomes relating to physical and emotional goals, as assessed by the GAS-D and standard patient- and clinician-reported measures. When assayed for convergent validity in a separate analysis, changes in goal scores on the GAS-D were statistically significantly correlated with multiple commonly used clinical measures of depression assessed in this study. The GAS-D approach provides a new patient-centric paradigm for the collaborative development and assessment of progress toward meaningful treatment goals, contributing to a comprehensive evaluation of treatment outcomes in patients with MDD. Longer studies against a control intervention are justified. Trial registration ClinicalTrials.gov identifier: NCT02972632 . Registered 21 November 2016.
... Indeed, in a previous review, it has been shown that dance is emotionally, mentally, physically and socially beneficial and that these are important aspects to address in the therapeutic management of illness [32]. Adding a spectacle as the final goal of the dance training session, may have added more motivation and induce a strong effect on happiness in the experimental group, as suggested in a previous review investigating the effects of goal setting on health outcomes in patients with various disabilities [33]. ...
Article
Objective Evaluate the effects of a 16-week a specific dance training program on motor function and well-being in patients with Parkinson Disease (PD). Methods Patients were allocated either to the experimental group or to the control group (no intervention). In the experimental group, patients practiced dance once a week for a total of 16 sessions. Dance sessions consisted of a choreography with the aim of performing a dance performance at the end of the 16-week dance program. At baseline and after 16 weeks, motor functions, patients’ feeling of happiness and cognitive functions were collected. Differences between the two groups were calculated for each tested measure. Results Eight patients in the experimental group and 6 in the control group completed the study. A significant difference between the two groups was found for the 10-meter test as well as for the feeling of happiness. No differences were found for the other outcomes. In conclusion, weekly sessions of dance improve motors capacities and the feeling of happiness in patients with PD. The motivational aspect of learning a choreography and presenting a dance performance may have induced additional benefits of the training program.
... The findings from a Cochrane systematic review of 39 RCTs involving 2846 patients mainly with persistent musculoskeletal disorders and chronic pain, indicates that goal setting may have positive effects for psychosocial outcomes (e.g. improved health related quality of life, emotional status, and self-efficacy), rather than physical ones [54]. ...
Article
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Background There is a need to improve consultations between patients with persistent musculoskeletal low back pain and orthopaedic spine clinicians when surgery is not indicated. Poor communication and lack of education about self- management in these consultations have been shown to be associated with increased distress and higher subsequent health care seeking. Aim To develop a standardised intervention to improve spine care consultations for patients for whom surgery is not beneficial. Method The intervention was developed in six stages. The first three stages included: interviews with patients, an interactive workshop with clinicians from a mix of disciplines, and interviews with spine clinicians about their perspective of the recommendations, their perceived difficulties and potential improvements. Information from these stages was synthesised by an expert panel, creating a draft intervention structure and content. The main features of the intervention and the materials developed were then reviewed by patients and spine clinicians. Finally, the research team incorporated the recommended amendments to produce the intervention. Results In total, 36 patients and 79 clinicians contributed to the development of the intervention. The final intervention includes three components: a pre-consultation letter with information suggesting that surgery is one possible intervention amongst many, introducing the staff, and alerting patients to bring with them a potted history of interventions tried previously. The intervention includes short online training sessions to improve clinicians’ communication skills, during the consultation, in reference to listening skills, validation of patients’ pain, and use of appropriate language. Clinicians are also supplied with a list of evidence-based sources for advice and further information to share with patients. Finally, post consultation, a follow up letter includes a short summary of the patients’ clinical journey, the results of their examination and tests, and a reminder of recommendations for self-management. Conclusion The intervention includes aspects around patient education and enhanced clinician skills. It was developed with input from a multitude of stakeholders and is based on patients’ perceptions of what they would find reassuring and empowering when surgery is excluded. The intervention has the potential to improve the patients care journey and might lead to changes in practice in spine clinicians.
... Second, such goal setting might improve allocation of resources. Finally, structured goal setting can result in higher levels of motivation, self-efficacy and health-related quality of life [53]. ...
Article
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Foot orthoses have been used for decades despite uncertainty surrunding their therapeutic efficacy. Orthoses have been used exclusively to affect neuro-biomechanical input and outcome variables, however, there is emerging evidence that therapeutic efficacy may be affected by a psychological stimulus. Critical appraisal of the literature highlights that there is no holistic model upon which foot orthosis practice is taught, practised nor investigated. This paper introduces a conceptual model of foot orthosis practice ( Valu e B a sed Foo t Orthosis P r actice (VALUATOR) model) that embraces a broader range of factors that are pertinent to orthosis practice, incorporating contemporary health service behaviours and values into orthosis practice for the first time. Within the VALUATOR model, foot orthosis design and clinical value is considered along a bio-psycho-social-digital continuum that reflects the reality of foot orthosis practice. The model contextualises the variable outcomes that are observed in research and practice within 6 key areas: 1) value, 2) person-centered approach, 3) zone of optimal bio-psycho-social stress, 4) bio-psycho-social assessment, 5) monitoring, 6) primary and secondary clinical strategies. The VALUATOR model is targeted at students, lecturers, scientists and practitioners and includes carefully chosen terminology to support a robust basis for educational and scientific discussion. It is believed that it provides a contemporary viewpoint and a structured conceptual metaphor that builds on existing evidence from a wide range of sources, invites constructive intellectual debate, and is anchored in the experiences of practitioners too. Stress testing the VALUATOR model will help determine its model and support further developments and evolution of orthotic practice in a evidence based way.
... There is also a crucial role for self-management across the lifetime for skill acquisition and the development of lived experience knowledge following SCI (Department , 2019). However, a Cochrane review on goal planning in acquired disability (Levack et al., 2015) found that there is insufficient information to say whether goal setting increases or reduces the risk of adverse events such as hospital secondary admission, because there is too much disparity between the variety of approaches, and as well, greater knowledge is required of the essential ingredients, such as how difficult goals are, goals selected and progress measured. ...
Chapter
Spinal cord injury (SCI) is a neurological condition arising from traumatic injury or disease that not only impairs voluntary motor control and sensory function, but causes disturbances in the autonomic nervous system, affecting cardiovascular, cognitive, bladder and bowel functions among others. People with a SCI experience psychosocial challenges in adjustment that range from changes with sexuality, weight gain, poor sleep, impaired cognitive performance and chronic pain to relationship stress and breakdown, social discrimination and reduced employment prospects. Consequently, people with a SCI have a high risk of deterioration in mental health, including substance abuse, depression and anxiety disorder. This article will present best evidence on the nature of SCI and its challenges and present a model that explains how people with SCI adjust to the injury. Efficacy of psychological interventions for people with SCI will be reviewed, and future directions in professional psychological approaches to addressing the burden of SCI will be discussed.
... Goal setting and goal management is a core routine rehabilitation practice that can determine overall care planning, quality of care, and health outcomes (1)(2)(3)(4)(5). Evidence indicates that the implementation of theory-based, client-engaging goal setting and goal management can help clinicians build a better understanding of clients' goals, daily life performance, environment, etc., so they can provide quality person-centered rehabilitation to enhance clients' health (6,7). Despite such evidence, theory-based, client-engaging goal setting and goal management is not well-implemented in current communitybased rehabilitation (8). ...
Article
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Aims This study aims to identify implementation determinants, mechanisms of action, implementation strategies, and implementation outcome evaluation plans for a new theory-based rehabilitation goal setting and goal management intervention system, called MyGoals, using Implementation Mapping with community-based participatory research principles. Methods We completed Implementation Mapping tasks 1 to 4 as a planning team consisting of MyGoals target implementers (occupational therapists (OTs), MyGoals intervention target clients (adults with chronic conditions), and the research team. We are currently conducting mapping task 5. These processes were guided by the Consolidated Framework for Implementation Research, social cognitive theory, the taxonomy of behavior change methods, and Proctor's implementation research framework. Results We identified intervention-level determinants ( MyGoals' evidence strength & quality, relative advantages ) and OT-level determinants ( knowledge, awareness, skills, self-efficacy, outcome expectancy) . We selected the MyGoals implementation outcome ( OTs will deliver MyGoals completely and competently ), outcome variables ( acceptability, appropriateness, feasibility, fidelity) , and process outcomes. We also determined three performance objectives (e.g., OTs will deliver all MyGoals intervention components) and 15 change objectives (e.g., OTs will demonstrate skills for delivering all MyGoals intervention components) . Based on the identified outcomes, objectives, and determinants, we specified the mechanisms of change (e.g., active learning) . To address these determinants and achieve the implementation outcomes, we produced two tailored MyGoals implementation strategies: MyGoals Clinician Education and MyGoals Clinician Audit & Feedback . We developed evaluation plans to explore and evaluate how these two MyGoals implementation strategies perform using a mixed-methods study of OT-client dyads. Conclusion We produced tailored implementation strategies for a rehabilitation goal setting and goal management intervention by using Implementation Mapping with community-based participatory research principles. The MyGoals implementation strategies may help OTs implement high-quality goal setting and goal management practice and thus contribute to bridging current research-practice gaps. Our findings can provide insight on how to apply implementation science in rehabilitation to improve the development and translation of evidence-based interventions to enhance health in adults with chronic conditions.
... A Cochrane systematic review of RCTs (N = 39) including patients with musculoskeletal disorders and chronic pain found evidence that goal setting improved health-related quality of life and self-reported emotional status (n = 8 studies; 446 participants) in adult rehabilitation compared with no goal setting. 82 Similar findings were reported in a 2010 study by Christiansen et al. 83 This study examined the relationship between improved functional outcomes and goal-setting strategies by combining the use of mental contrasting, implementations, and cognitive behavioral therapy as a means to evaluate their effectiveness in improving disability compared with a control group. At a high level, patients were asked to list positive aspects associated with "exercising more" (ie, increasing their physical capacity) and four negative aspects (ie, obstacles) that would need to be confronted to achieve this goal. ...
Article
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Chronic pain is often associated with functional limitations that have a huge impact on patients' lives. However, despite being relatively common, chronic musculoskeletal pain is still viewed by some as a symptom of another disease rather than its own condition, and is therefore poorly addressed. This is compounded by other challenges in the field, including education gaps for both healthcare professionals and patients, a lack of universal and comprehensive assessment tools, poor societal perceptions of chronic pain, and the current stigma around the use of opioids. Here, we review the current chronic musculoskeletal pain management landscape in the United States and offer professional insight into emerging methods that can be used to improve patient outcomes, in particular, the achievement of meaningful functional goals. This perspective incorporates our combined multidisciplinary (psychiatry, psychology, nursing, physical therapy, and general medicine) experience and insights. We believe that chronic pain is a multifactorial experience and treatment requires an integrated, multidisciplinary approach from a range of healthcare providers. For the best patient outcomes, this team should work together to assess and treat the patient as a whole, addressing their pain and also providing education, empowerment, and support to enable patients to set and achieve meaningful functional goals that will provide real improvement in their quality of life. We believe that the healthcare community should elevate the conversation around chronic musculoskeletal pain management beyond that of just pain, to encompass the meaningful benefits that improvement in functional outcomes brings to patients.
... 12,13 A systematic review indicated that patient involvement in setting rehabilitation goals could improve patient outcomes, including health-related quality of life, emotional health, and self-efficacy. 14 Both PCC and collaborative goal setting provide shared goals for clinicians and patients, elevate patients' self-determination, and encourage active patient engagement in therapy. Last, the International Spinal Cord Society has identified teamwork, shared goal-setting, and patient engagement as recommended knowledge and skills for SCI/D medicine. ...
Article
Objectives This study aimed to describe the process of adapting an evidence-based patient engagement intervention, Enhanced Medical Rehabilitation (E-MR), for inpatient spinal cord injury/disease (SCI/D) rehabilitation using an implementation science framework. Design We applied the Collaborative Intervention Planning Framework (CIPF) and included a community advisory board (CAB) in an intervention mapping process. Setting A rehabilitation hospital. Participants Stakeholders from inpatient SCI/D rehabilitation (N=7) serving as a CAB and working with the research team (N=7) to co-adapt E-MR. Interventions E-MR Main Outcome Measures Logic model and matrices of change used in CAB meetings to identify areas of intervention adaptation. Results The CAB and research team implemented adaptations to E-MR, including (1) identifying factors influencing patient engagement in SCI/D rehabilitation (e.g., therapist training); (2) revising intervention materials to meet SCI/D rehabilitation needs (e.g., modified personal goals interview and therapy trackers to match SCI needs); (3) incorporating E-MR into the rehabilitation hospital's operations (e.g., research team coordinated with CAB to store therapy trackers in the hospital system); and (4) retaining fidelity to the original intervention while best meeting the needs of SCI/D rehabilitation (e.g., maintained core E-MR principles while adapting). Conclusions This study demonstrated that structured processes guided by an implementation science framework can help researchers and clinicians identify adaptation targets and modify the E-MR program for inpatient SCI/D rehabilitation.
... This has been reflected elsewhere, as stroke survivors who report a perceived involvement in their care and treatment are associated with reporting their recovery service needs being met (87). More specifically, met needs have also been associated with shared decision-making in the rehabilitation goal-setting process (88,89). Yet, when it comes to managing conversations about post-stroke recovery and adjustment with stroke survivors, the participants described how HCPs must find a balance between providing encouragement to engage with rehabilitation while managing expectations about the reality of potential long-term impairments. ...
Article
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Background Stroke survivor narratives can provide valuable insight into experiences of healthcare and beyond. There is need to further understand collective lessons from stroke survivor narratives, yet prior studies utilizing digital storytelling tend to not synthesize lessons from individual experiences. This study aims to develop a novel method to co-create digital stories with stroke survivors that will aim to synthesize and portray important collective lessons from individual stroke survivors' experiences of interacting with healthcare professionals. Methods This study follows-up a qualitative study conducted with 30 stroke survivors exploring factors that help or hinder survivors to positively reconfigure their identity post-stroke. Five co-creation workshops were conducted with a subset of UK-based stroke survivors from this previous study. Participants were invited to join through: online workshops, an online bulletin board, and as an advisor. A four-stage workshop framework was developed through the integration of UK Design Council's Double Diamond method, digital storytelling strategies and the Behavior Change Wheel (BCW) framework for developing behavioral change interventions. Findings Six online workshop participants (three male, three female; aged 33–63; time since stroke 2–16 years) co-created digital stories that share six collective lessons aimed at increasing empathy and encouraging behavior change in healthcare professionals (HCPs) working with stroke survivors. Online bulletin board participants ( n = 1) and advisors ( n = 5) supported the co-creation process. Collective lessons identified were: (1) Stroke has a variety of symptoms that must all be considered; (2) Stroke can affect anyone of any age and not just the elderly; (3) Assumptions should not be made about a survivor's lifestyle or habits; (4) It is important to acknowledge the person behind the stroke and ensure that they are communicated with and listened to; (5) Stroke survivors can often feel unprepared for the reality of life after stroke; (6) Adapting to life after stroke is a long-term process requiring long-term support. Conclusion Stroke survivor stories highlighted preconceptions, attitudes and behaviors embedded within healthcare that negatively impacted their experiences and recovery. The novel methodology employed in this study enabled these stories to be synthesized into collective lessons to bring about improvements in these behaviors in future.
... Playford (2019) outlined the many facets of goal setting as building empathy, creating a contract, identifying priorities, summarizing the conversation, articulating the goal, defining actions, building coping plans and then reviewing [35]. However, the evidence on the impact of goal setting for successful rehabilitation is not strong [36]. Transferring of what has been achieved during rehabilitation was a major goal reported in the interviews. ...
Article
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Background Managing multiple sclerosis (MS) includes different treatment approaches. Rehabilitation is a key strategy in MS for improving functioning, activity and participation. As part of a larger study on overall patient experiences with different treatment approaches, this study aims to give an overview of different patients’ experiences and perspectives on inpatient rehabilitation in MS. Methods We conducted problem-centered interviews in 50 persons with MS in Germany, of whom most had relapsing–remitting MS. We used the maximum variation sampling method during recruitment. Data were analyzed thematically. Results As a result of the analysis, three major themes were identified: 1) factors contributing to the decision-making concerning rehabilitation, 2) experience with the rehabilitation setting, 3) benefits of rehabilitation treatments. The treating physicians’ attitude had a major impact on the decision to either opt for rehabilitation or not. Setting goals prior to rehabilitation was given a high priority. Exchanging experiences with other persons with MS presented a major benefit from rehabilitation while for some being separated from regular daily life resulted in a more ambiguous attitude ranging from appreciation of escaping daily hassles to substantial behavioral change management. Conclusion Patients reported various experiences in the process of decision-making with regard to rehabilitation. Physicians´ advice, goal setting and the selection of the most suitable rehabilitation clinic were considered most relevant.
... 739) and commented on the difficulty of the field in comparing goal planning programmes because of the variability in methodology. A Cochrane Review of goal pursuit in acquired disability was again impacted by the variation in terminology and methods and thus found only low quality evidence, concluding "the best evidence appears to favour positive outcomes (i.e., health-related quality of life, emotional status and self-efficacy) rather than physical ones" and said key research was needed to understand "how components of the goal setting process (such as how difficult goals are, how goals of therapy should be selected and prioritised, how goals are used in clinical practice, and how feedback on progress towards goals should be provided) contribute or do not contribute to better health outcomes" [38] (p. 2). ...
Article
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Goal planning is core for the delivery of the biopsychosocial model of rehabilitation and is commonly practiced in spinal cord injury (SCI) and other physical health settings. Despite a strong theoretical basis from several branches of psychology, evidence regarding specific practice, interventions and impact has yet to be established, with no universal standards in this area. Study One outlines the standards used at the National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital since the inception of the SMS-NAC and goal planning programme in 1989. The results outline the impact of a quality improvement project undertaken since 2016 and track the interventions used to improve inpatient care. Study Two reports on an international survey of rehabilitation measure usage and goal planning practice with inpatient adult and children and young people (CYP) with SCI. Respondents replied that inpatient presence at goal planning meetings only took place in 75% (adult) and 76% (CYP) of services, with more services indicating 4 or more members of the multidisciplinary team being present (85% and 90%, respectively). This paper demonstrates the gains that can be made when a structured quality improvement methodology is used and highlights the need for standards regarding goal planning in SCI rehabilitation to be developed. Keywords: goal planning; goal setting; rehabilitation outcome; Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC)
... In general, the patient is supposed to fit in a standard procedure not necessarily adapted to her/his own needs, objectives and internal physiological rhythms. In this context, evidence to either support or refute the hypothesis that conventional rehabilitation interventions improve the targeted function is of insufficient quality [10,[76][77][78]. ...
Article
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Neurological disorders often cause severe long-term disabilities with substantial activity limitations and participation restrictions such as community integration, family functioning, employment, social interaction and participation. Increasing understanding of brain functioning has opened new perspectives for more integrative interventions, boosting the intrinsic central nervous system neuroplastic capabilities in order to achieve efficient behavioral restitution. Neurorehabilitation must take into account the many aspects of the individual through a comprehensive analysis of actual and potential cognitive, behavioral, emotional and physical skills, while increasing awareness and understanding of the new self of the person being dealt with. The exclusive adoption by the rehabilitator of objective functional measures often overlooks the values and goals of the disabled person. Indeed, each individual has their own rhythm, unique life history and personality construct. In this challenging context, it is essential to deepen the assessment through subjective measures, which more adequately reflect the patient’s perspective in order to shape genuinely tailored instead of standardized neurorehabilitation approaches. In this overly complex panorama, where confounding and prognostic factors also strongly influence potential functional recovery, the healthcare community needs to rethink neurorehabilitation formats.
... Goal-oriented rehabilitation with patient involvement is considered a key approach to rehabilitation [33,34], and has been shown to increase patient satisfaction and adherence [35], as well as improve self-efficacy, health-related quality of life and emotional status. There is, however, a need for more methodologically rigorous studies involving the use of individualized and specific treatment goals [36]. Although some studies have demonstrated the utility of a goal-oriented approach in tailoring rehabilitation efforts to the heterogeneous functional difficulties due to persistent TBI symptoms [37,38], more high-quality studies are needed on the effect of such approaches in the chronic phase of TBI. ...
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Traumatic brain injury (TBI) is a heterogeneous condition with long-term consequences for individuals and families. Goal-oriented rehabilitation is often applied, but there is scarce knowledge regarding types of goals and goal attainment. This study describes goal attainment in persons in the chronic phase of TBI who have received an individualized, SMART goal-oriented and home-based intervention, compares goal attainment in different functional domains, and examines indicators of goal attainment. Goal attainment scaling (GAS) was recorded in the intervention group (n = 59) at the final session. The goal attainment was high, with 93.3% increased goal attainment across all goals at the final session. The level of goal attainment was comparable across domains (cognitive, physical/somatic, emotional, social). Gender, anxiety symptoms, self-reported executive dysfunction, and therapy expectations were indicators of goal attainment. These results indicate a potential for the high level of goal attainment in the chronic phase of TBI. Tailoring of rehabilitation to address individual needs for home-dwelling persons with TBI in the chronic phase represents an important area of future research.
Article
Australian health and aged care reforms mandate a wellness and reablement (W&R) approach with services and the workforce needing to adjust their way of working with older people, to actively promote independence and participation in life's activities. Studies exploring the older person's perspective are sparse. This study aims to understand the older person's experience of a W&R approach, supplemented with experiences of staff trained in the approach. The study evaluates a W&R approach implemented across three community-based sites of a large Australian aged care provider. Staff from participating sites underwent training and were asked to use a W&R approach with at least one older person. Eighteen older people aged 65+ were engaged in the 4-month programme. Semi-structured interviews with older people and staff were conducted on completion of the programme. The W&R approach showed variable benefits and experiences of older people related to goal setting and outcomes. Overall, older people were unfamiliar with goal setting or displayed negative attitudes. Negative emotional responses to health decline and ageing, such as apathy, frustration, embarrassment and sense of helplessness, were identified as barriers to goal pursual. In contrast, enabling factors, such as assistive equipment, staff and social connection, triggered positive emotional responses, which acted as protective factors and enhanced goal pursual. Staff knowledge and understanding of the W&R approach also influenced older people's experience and outcomes. These findings recommend a stronger focus on the social and emotional aspects of W&R and co-developing goals in line with the older person's sense of wellbeing. This approach supports the multiple dimensions of W&R and aligns with principles of positive and healthy ageing. Additional training for staff should be provided, with ongoing mentoring and support from W&R champions. Ensuring that goals are meaningful and valuable to individual older people will enhance successful goal pursual and improve outcomes.
Article
The aim of this paper is to report our notes from the field on using movement toward goals at an aggregate level as an inference of service effectiveness. Analysis of routinely collected data from UK youth mental health services was conducted (N = 8,172, age M = 13.8, 67% female, 32% male) to explore the impact of including goal‐based outcome data in combined calculations of standardized measures based on the principles of reliable change (“measurable change”). Due to the broad nature of standardized measures, inferred validity becomes diluted in any team or service level aggregate analysis. To make inferences that are closer to the person's interpretation of their difficulties, we argue that Idiographic Patient Reported Outcome Measures (I‐PROMs) counterbalance these limitations. This is supported by our findings. The measurable change metric is the first step towards enabling national analysis of aggregated I‐PROMs. I‐PROMs, supplemented by standardized measures should be used to consider service evaluation.
Chapter
Eine ICF-orientierte Befunderhebung und Zielplanung erleichtert es Betroffenen und Behandlern, geeignete Interventionsstrategien auszuwählen und deren Wirksamkeit zu überprüfen. Im Sinne des Shared-Decision-Making und mittels Top-down-Betrachtung werden die Betroffenen und ihre Bezugspersonen in Informations- und Entscheidungsprozesse eingebunden. Da bei der funktionellen Elektrostimulation ein hoher Anteil an Eigeninitiative ggf. auch der Angehörigen erforderlich ist, haben Aspekte des Selbstmanagements einen besonderen Stellenwert bei der Zielformulierung. Fortschritte sollten idealerweise immer mit entsprechenden Messverfahren (Assessments) überprüft werden. Das Erreichen von Zielen stellt keinen Endpunkt (außer für den aktuellen Behandlungszyklus) dar, sondern vielmehr einen Ausgangspunkt für einen (möglichst) höheren Grad an Unabhängigkeit und Selbstbestimmung.
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Purpose While resilience is seen as fundamental to recovery and rehabilitation processes within the psychology discipline, (Bonanno, 2004), it has received little acknowledgement throughout speech pathology literature. Research suggests that targeting the malleable components associated with the recruitment and development of resilience has the potential to optimize acquired brain injury (ABI) rehabilitation outcomes. This article examines key constructs fundamental to understanding resilience and provides examples of existing evidence-based practices that can be feasibly incorporated into existing neurorehabilitation practices to drive the establishment of resilience. Method Articles describing resilience models and frameworks were examined to identify resilience factors that could be fostered during neurorehabilitation therapy sessions. Results The literature supports a series of common traits across resilience intervention models that enhance the development of resilience including the promotion of optimism, motivation, self-efficacy, and interpersonal connectedness. We describe a number of established communication strategies and counseling techniques that promote these resilience factors and can be integrated into rehabilitation therapy sessions. Conclusions Speech pathologists should consider resilience as a primary and essential clinical ingredient in their rehabilitation interventions. It is important that clinicians are trained in the communication and counseling skills that comprise these ingredients. Bolstering resilience while addressing rehabilitation targets can optimize clinical outcomes.
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Chronic diseases often demand considerable work by patients: they must adhere to medical regimes and engage with social and embodied discontinuities. In Denmark, rehabilitees in Parkinson's disease rehabilitation talk about Parkinson's as their new job. In this article, we introduce goal-work as an optical lens to enlarge and explore the micro-social practices that concern a core practice in rehabilitation where professionals and rehabilitees set goals for the future and work toward the goals. To work with goals adds a new task to living with Parkinson's. Rehabilitation research tends to focus on the actual goal-setting meeting. Drawing on data from long-term ethnographic fieldwork on goals and their setting in Parkinson's disease rehabilitation, we show how participants in rehabilitation imagine, set, enact, review or share their rehabilitation goals, and how goals are worked with before and after the goal-setting meeting, across settings. We conceptualize these micro-social practices as goal-work, which we argue is a spatio-temporal process. The concept of goal-work emphasizes the fact that goal-setting is one event in a string of goal-related activities, and it turns our attention to the intersubjective dimensions inherent in goal-work, such as the role of relatives and how acts of imagination and acts of sharing form part of goal-work.
Chapter
Dieses Kapitel beschäftigt sich mit der Planung und den Rahmenbedingungen einer Aphasie-Therapie. Fragen der Wirksamkeit und ICF-orientierten Zielsetzung der Therapie werden ebenso behandelt wie die unterschiedliche Ausrichtung der Therapie im Verlauf einer Aphasie. Zahlreiche Faktoren, die bei der Therapieplanung zu berücksichtigen sind, werden erläutert. Hierzu gehören z. B. Beginn und Intensität einer Therapie oder Auswahlkriterien für Übungen und Material.
Article
Objective This systematic review aims to examine 1) what components are used in current person-centered goal setting interventions for adults with health conditions in rehabilitation and 2) the extent to which the engagement of people in their rehabilitation goal setting is encouraged. Data Sources PubMed/MEDLINE, EMBASE, Cumulative Index of Nursing and Allied Health Literature, SCOPUS, and Web of Science from inception to November 2020. Study Selection Primary inclusion criteria were peer-reviewed articles that evaluated person-centered goal setting interventions for adults with health conditions in rehabilitation. Two independent reviewers screened 28,294 records, and 22 articles met inclusion criteria. Data Extraction Two reviewers independently completed data extraction and quality assessment using the Physiotherapy Evidence Database (PEDRo) scale based on the original authors’ descriptions, reports, and protocol publications. Any discrepancies were resolved by consensus or in consultation with another senior reviewer. Data Synthesis Using narrative synthesis, we found that current person-centered goal setting has variability in their inclusion of intervention components. A considerable number of components are under-implemented in current practice, with formulation of coping plan and follow-up being most commonly left out. The active engagement of people does appear to be promoted within the components that are included in the interventions. Nine studies were high-quality defined as a total PEDro scale score of 6 or above. Conclusions Although current person-centered goal setting encourages the active engagement of people, many of these interventions lack components considered important for supporting goal achievement and optimal outcomes. Future practice may be improved by incorporating a comprehensive set of goal setting components and encouraging the active engagement of people throughout the entire goal setting process. Together, these practices may facilitate the achievement of meaningful rehabilitation goals and improve rehabilitation outcomes for adults with health conditions.
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Background Patient centred care (PCC) positively influences individual and organisational outcomes. It is important that dietitians working in rehabilitation units are supported to deliver PCC, as effective rehabilitation is a collaborative and patient centred process. The objective of this scoping review was to explore the literature available regarding the delivery of dietetic PCC, with patients undergoing rehabilitation in subacute inpatient units. Methodology PubMed, MEDLINE, CINAHL, Embase and Scopus were searched for relevant published literature. Searches for grey and unpublished literature were also completed. Studies were eligible for inclusion and data extraction if they demonstrated the delivery of PCC by qualified dietitians, through individual consultations with adult patients undertaking subacute rehabilitation. Results Overall, 675 studies were identified and six were included in the review. From the literature available, documentation was lacking regarding conceptualisation and delivery of patient centred nutrition care, with only one study providing quality indicators for patient centred dietetic services. Elements of PCC cited were mostly limited to phrases such as, 'individualised care', 'tailored advice', 'follow-up', and 'team collaboration'. Conclusion This scoping review identified a considerable gap in the literature regarding the delivery of dietetic PCC in subacute rehabilitation units. Contemporary descriptions of PCC show that delivery of care which is truly patient centred is far more comprehensive than individualising interventions or organising ongoing services. This raises the question, is the delivery of nutrition care in subacute rehabilitation unit's patient centred? This article is protected by copyright. All rights reserved.
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Due to its goal-orientation, rehabilitation may be considered a future-oriented practice. As rehabilitation is increasingly recognized as contributing to dementia care it is important to explore how rehabilitation corresponds with the future orientation of older people with dementia. The aim of this study was to explore the futurework of home-dwelling people with mild to moderate dementia in the context of rehabilitation-focused municipal dementia care, that is, their thinking and practices regarding their future and how these correspond with institutionalized practices. The study was conducted as a case-study inspired by the methodology of Institutional Ethnography (IE). The study setting was two Danish municipalities sampled as a paradigmatic case. Eight older people living with early-stage dementia (mean age: 78 years, age range: 65–91) were strategically sampled and each interviewed recurringly within a period of six through 15 months. In total, 29 interviews were completed. An abductive analysis was subsequently conducted based on these interviews. Findings included three dimensions of futurework: Extending the present state into the near future; avoiding being confronted with an anticipated future; and adjusting to decline and preparing for future losses. Based on these findings, a notion of ‘ambivalent futurework’ is suggested. The futurework of older people did not always correspond with the institutional arrangements in a rehabilitation-focused dementia care. Findings show that the institutional arrangements in dementia care may support as well as challenge the futurework of the participants. Paying attention to the ambivalences of older people living with dementia and recognizing the ambivalent futurework may be essential in rehabilitation-focused dementia care.
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Aim This review assessed the effectiveness of interventions using a goal-setting approach on glycaemic control for people diagnosed with prediabetes or type 2 diabetes. Design A systematic review guided by the Joanna Briggs Institute methodology for conducting systematic reviews of primary research studies was conducted. Data Sources Randomized controlled trials and experimental studies with a minimum follow-up period of 6 months were considered for inclusion. The primary outcome was change in glycaemic control as measured by glycated haemoglobin (%) and/or fasting plasma glucose (mg/dl). A systematic search of seven electronic databases was completed in October 2020. Review Methods Papers meeting the inclusion criteria were critically appraised using the Joanna Briggs Institute tools for critical appraisal followed by data extraction. A Grading of Recommendations Assessment, Development and Evaluation assessment was conducted to assess the overall certainty of the evidence. Fixed-effect meta-analyses were completed to demonstrate the mean effect for each outcome of interest. Results Twenty one studies were included in this review. Goal setting was more effective than usual care for glycaemic control in prediabetes at 6 months and at 12 months for fasting plasma glucose (mg/dl) and glycated haemoglobin (%). Goal setting was more effective than usual care for glycaemic control in type 2 diabetes for fasting plasma glucose (mg/dl) at 6 months, fasting plasma glucose (mg/dl) at 12 months, glycated haemoglobin (%) at 6 months and glycated haemoglobin (%) at 12 months. Conclusion The evidence suggests goal setting is effective in supporting people to achieve glycaemic targets in prediabetes and type 2 diabetes.
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Physical activity interventions are recommended for people with chronic obstructive pulmonary disease (COPD). However, adherence is low. This scoping review aimed to provide detailed descriptions of physical activity counseling interventions for people with COPD that have been studied in randomized controlled trials. Common components included the use of pedometers/activity monitors, goal setting, and recording physical activity in a written or electronic diary. Clinicians could consider including these components within their management of people with COPD to promote increased physical activity levels. Additional research is needed to determine the key components that drive physical activity behavior change in this population.
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The SMART acronym (e.g., Specific, Measurable, Achievable, Realistic, Timebound) is a highly prominent strategy for setting physical activity goals. While it is intuitive, and its practical value has been recognised, the scientific underpinnings of the SMART acronym are less clear. Therefore, we aimed to narratively review and critically examine the scientific underpinnings of the SMART acronym and its application in physical activity promotion. Specifically, our review suggests that the SMART acronym: is not based on scientific theory; is not consistent with empirical evidence; does not consider what type of goal is set; is not applied consistently; is lacking detailed guidance; has redundancy in its criteria; is not being used as originally intended; and has a risk of potentially harmful effects. These issues are likely leading to sub-optimal outcomes, confusion, and inconsistency. Recommendations are provided to guide the field towards better practice and, ultimately, more effective goal setting interventions to help individuals become physically active.
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Rationale, aims and objectives: The field of implementation science is critical for embedding research evidence into healthcare practice, benefiting individuals, organizations, governments, and the broader community. Implementation science is messy and complex, underpinned by many theories and frameworks. Efficacious interventions for older people with multiple comorbidities exist, yet many lack effectiveness evaluation relevant to pragmatic implementation within aged care practice. This article outlines the conceptualization and development of an Implementation Framework for Aged Care (IFAC), fit-for-purpose for an aged care organization, Bolton Clarke, intent on embedding evidence into practice. Method: A four-stage process was adopted to (1) explore context and relevant literature to conceptualize the IFAC; (2) identify key elements for a draft IFAC; (3) expand elements and refine the draft in consultation with experts and (4) apply the IFAC to three existing projects, identifying key learnings. A checklist to operationalize the IFAC was then developed. Results: The IFAC is grounded in codesign principles and encapsulated by the implementation context, from a social, cultural and political perspective. The IFAC addresses the questions of (1) why do we need to change?; (2) what do we know?; (3) who will benefit?; (4) who will make the change?; (5) what strategies will be used?; and (6) what difference are we making? Three pilot projects: early adoption of a Wellness and Reablement approach; a care worker and virtual physiotherapist-led program to prevent falls; and a therapeutic horticulture program for residential communities, highlight learnings of applying the IFAC in practice. Conclusion: This fit-for-purpose IFAC was developed for a proactive and responsive aged care provider. The simplicity of the six-question IFAC is underpinned by substantial theoretical perspectives for its elements and their connections. This complexity is then consolidated into an 18-question checklist to operationalize the IFAC, necessary to advance the translation of evidence into clinical practice.
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Rehabilitation medicine has expanded the horizon of all medicine and brought about new human achievements. To facilitate continued advances in achievement, several changes are suggested in customary rehabilitation strategic goals, concepts, and practices. The main rehabilitation goals should focus on prolonged survival, contrary to the opinions of most authors on rehabilitation, and on achievement of maximum ability realization, rather than of independence or any given (including previous) level of functioning. Setting rehabilitation goals should benefit the patient, rather than the caregiver or the insurer. Training should focus on tasks that contribute to the patients’ interests and desires, rather than on any task that reduces the burden of care. The main criterion for admission to a rehabilitation ward should be based on expected advantage in prolonging patient survival and maximizing ability realization.
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Introduction Neuromodulation for pain has been successfully applied for decades, in that the goals and expectations that patients aim to achieve are clearly described. Nevertheless, the point of view of health care providers is less clear. Therefore, this study aimed to explore the goals, expectations, and definition of success for neuromodulation for pain according to health care providers. Materials and Methods An online survey was developed and spread at the 2nd Joint Congress of the International Neuromodulation Society (INS) European Chapters in September 2021 in Paris. Respondents were asked 1) to select the goals to treat patients with neuromodulation for pain, 2) to indicate factors that they expect to change according to neuromodulation for pain, and 3) to provide their definition of success of neuromodulation for pain. Results We approached 101 respondents, of whom 88 health care providers at least partly completed the survey. Increasing mobility/functionality (26.7%), decreasing pain intensity (24.5%), and decreasing medication use (16.6%) were the most frequently reported goals of neuromodulation. The same top three variables were selected as factors that health care providers expected to change. For the definition of success, quality of life of patients outranked other definitions. Other highly ranked definitions, in descending order, were obtaining pain relief, increasing functionality, and increasing patient satisfaction. Discussion Goals and expectations of health care providers are not completely in line with previously explored goals of patients that are related to pain relief and improving walking abilities. Health care providers seem to put a high emphasis on the quality of life of the patient when evaluating the success of neuromodulation, which is not completely aligned with the currently used reimbursement rules that are mainly focusing on pain relief instead of incorporating health-related quality of life. Clinical Trial Registration The Clinicaltrials.gov registration number for the study is NCT05013840.
Article
Background Regular exercise has many benefits for adults with physical disabilities (AwPD). Despite these benefits, significant barriers to participating in exercise exist for AwPD. Community-based adaptive fitness centers promote exercise for AwPD by minimizing barriers. Research has yet to clearly examine the personal and environmental factors associated with enrollment and attendance rates of AwPD in community-based adaptive fitness centers. Objective The purpose of our study was to explore personal and environmental factors associated with AwPD and their attendance at a community-based adaptive fitness center once enrolled. Methods Individuals aged 18–85 with a physical disability interested in exercising were referred to a community-based adaptive fitness center. At initial assessment, participants completed demographics, health, barriers to exercise, and exercise self-efficacy (ESE) surveys. Following initial assessment, participant visits to the fitness center were tracked for six months. Results Of 106 participants, 27 never visited the facility after initial assessment, and the remaining participants with six months of attendance data (n=67) averaged 14.9 (SD=14.2) visits. Correlation results showed a negative curvilinear relationship between number of visits and years living with disability (rs=-0.24, p<0.05), with higher attendance associated with more recent diagnosis. Logistic and stepwise regressions showed that ESE scores (β=0.107, p=0.026) was the only significant predictor of attending the fitness center once enrolled. Conclusions This study demonstrates the importance of understanding personal and environmental factors and assessing ESE for AwPD who are newly enrolled in a community-based adaptive fitness center.
Article
Background Goal setting is widely used in mental healthcare, yet there is limited information about goal development between community pharmacists and people experiencing mental health conditions. Objectives i) To review goals developed in partnership between Australian community pharmacists and people experiencing depression/anxiety, and ii) categorize goals and develop a taxonomy. Methods Community pharmacists (n = 142) who had completed a mental health training program provided an individualized medication support service and documented goal planning for 350 people experiencing anxiety and/or depression. Goals were reviewed using a general inductive content analysis to develop themes which were then grouped, categorized, and coded. This involved three researchers in different phases of the coding, repeated review and redrafting of the taxonomy, and inter-rater reliability consistency checks. Results The goals (n = 749) represented a diverse range of health behaviors and outcomes (e.g., medication adherence, relationships, leisure activities). The resulting taxonomy involved five overarching domains: improved health; satisfaction with life; manage physical illnesses; manage mental health; and use of medicines. Conclusions Pharmacists have a role in providing person-centered care and addressing social determinants of health by considering factors that contribute to a person's overall wellbeing. While further testing is necessary, the taxonomy is valuable for pharmacists unfamiliar with supporting goal development with people experiencing anxiety and/or depression.
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Introduction: Cognitive effort can affect the execution of a wide range of tasks and is primarily involved in the regulation of cognitive control when performing the task and achieving the chosen goal. Aim: The purpose of this study was to determine the effect of easy and difficult goals on self-efficacy and memory performance in young and elderly people with an investigation of the cognitive effort hypothesis. Method: The present study is a semi-experimental study. The statistical population of this study was the young and elderly people in the sixth district of Tehran city and its statistical sample includes 80 young and elderly subjects who were selected in 2018 and were randomly assigned to eight experimental groups. To measure self-efficacy, a questionnaire of memory self-efficacy beliefs was used, and a stroop task was used to assess cognitive tasks. Data were analyzed using analysis of mixed covariance tests with repetitive measurements, two-way analysis covariance, and Bonferroni PostHoc test. Statistical analysis was performed using SPSS software version 20. Results: Results in high cognitive loads showed that young adults group with difficult goals have significantly better performance rather than other experimental groups (P<0.001). The results of tasks with low and high cognitive loads showed that younger adults group has better performance rather than older adults (P<0.05). The average self-efficacy beliefs in youth group with the easy goals were better than other groups (P <0.05). Conclusion: According to the findings of this study, the use of goals for promoting performance and memory self-efficacy beliefs in training is recommended.
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Objective: To examine the effects of a goal setting intervention on self-efficacy, treatment efficacy, adherence and treatment outcome in patients undergoing low back pain rehabilitation. Design: A mixed-model 2 (time) × 3 (group) randomized controlled trial. Setting: A residential rehabilitation centre for military personnel. Subjects: UK military personnel volunteers (N = 48); mean age was 32.9 (SD 7.9) with a diagnosis of non-specific low back pain. Interventions: Subjects were randomly assigned to either a goal setting experimental group (Exp, n = 16), therapist-led exercise therapy group (C1, n = 16) or non-therapist-led exercise therapy group (C2, n = 16). Treatment duration for all groups was three weeks. Main measures: Self-efficacy, treatment efficacy and treatment outcome were recorded before and after the treatment period. Adherence was rated during regularly scheduled treatment sessions using the Sports Injury Rehabilitation Adherence Scale (SIRAS). The Biering-Sørensen test was used as the primary measure of treatment outcome. Results: ANCOVA results showed that adherence scores were significantly higher in the experimental group (13.70 ± 1.58) compared with C2 (11.74 ± 1.35), (P < 0.025). There was no significant difference for adherence between the experimental group and C1 (P = 0.13). Self-efficacy was significantly higher in the experimental group compared to both C1 and C2 (P < 0.05), whereas no significant difference was found for treatment efficacy. Treatment outcome did not differ significantly between the experimental and two control groups. Conclusions: The findings provide partial support for the use of goal setting to enhance adherence in clinical rehabilitation.
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Attempts to tackle problems such as smoking and obesity increasingly use complex interventions. These are commonly defined as interventions that comprise multiple interacting components, although additional dimensions of complexity include the difficulty of their implementation and the number of organisational levels they target.1 Randomised controlled trials are regarded as the gold standard for establishing the effectiveness of interventions, when randomisation is feasible. However, effect sizes do not provide policy makers with information on how an intervention might be replicated in their specific context, or whether trial outcomes will be reproduced. Earlier MRC guidance for evaluating complex interventions focused on randomised trials, making no mention of process evaluation.2 Updated guidance recognised the value of process evaluation within trials, stating that it “can be used to assess fidelity and quality of implementation, clarify causal mechanisms and identify contextual factors associated with variation in outcomes.”3 However, it did not provide guidance for carrying out process evaluation
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Background: Intervention fidelity is concerned with the extent to which interventions are implemented as intended. Consideration of fidelity is essential if the conclusions of effectiveness studies are to be credible, but little attention has been given to it in the rehabilitation literature. We describe our experiences addressing fidelity in the development of a rehabilitation clinical trial, and consider how an existing model of fidelity may be employed in rehabilitation research. Methods: We used a model and methods drawn from the psychology literature to investigate how fidelity might be maximised during the planning and development of a stroke rehabilitation trial. We considered fidelity in intervention design, provider training, and the behaviour of providers and participants. We also evaluated methods of assessing fidelity during a trial. Results: We identified strategies to help address fidelity in our trial protocol, along with their potential strengths and limitations. We incorporated these strategies into a model of fidelity that is appropriate to the concepts and language of rehabilitation. Conclusion: A range of strategies are appropriate to help maximise and measure fidelity in rehabilitation research. Based on our experiences, we propose a model of fidelity and provide recommendations to inform the growing literature of fidelity in this discipline.
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Cultural competence education for health professionals aims to ensure all people receive equitable, effective health care, particularly those from culturally and linguistically diverse (CALD) backgrounds. It has emerged as a strategy in high-income English-speaking countries in response to evidence of health disparities, structural inequalities, and poorer quality health care and outcomes among people from minority CALD backgrounds. However there is a paucity of evidence to link cultural competence education with patient, professional and organisational outcomes. To assess efficacy, for this review we developed a four-dimensional conceptual framework comprising educational content, pedagogical approach, structure of the intervention, and participant characteristics to provide consistency in describing and assessing interventions. We use the term 'CALD participants' when referring to minority CALD populations as a whole. When referring to participants in included studies we describe them in terms used by study authors. To assess the effects of cultural competence education interventions for health professionals on patient-related outcomes, health professional outcomes, and healthcare organisation outcomes. We searched: MEDLINE (OvidSP) (1946 to June 2012); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) (June 2012); EMBASE (OvidSP) (1988 to June 2012); CINAHL (EbscoHOST) (1981 to June 2012); PsycINFO (OvidSP) (1806 to June 2012); Proquest Dissertations and Theses database (1861 to October 2011); ERIC (CSA) (1966 to October 2011); LILACS (1982 to March 2012); and Current Contents (OvidSP) (1993 Week 27 to June 2012).Searches in MEDLINE, CENTRAL, PsycINFO, EMBASE, Proquest Dissertations and Theses, ERIC and Current Contents were updated in February 2014. Searches in CINAHL were updated in March 2014.There were no language restrictions. We included randomised controlled trials (RCTs), cluster RCTs, and controlled clinical trials of educational interventions for health professionals working in health settings that aimed to improve: health outcomes of patients/consumers of minority cultural and linguistic backgrounds; knowledge, skills and attitudes of health professionals in delivering culturally-competent care; and healthcare organisation performance in culturally-competent care. We used the conceptual framework as the basis for data extraction. Two review authors independently extracted data on interventions, methods, and outcome measures and mapped them against the framework. Additional information was sought from study authors. We present results in narrative and tabular form. We included five RCTs involving 337 healthcare professionals and 8400 patients; at least 3463 (41%) were from CALD backgrounds. Trials compared the effects of cultural competence training for health professionals, with no training. Three studies were from the USA, one from Canada and one from The Netherlands. They involved health professionals of diverse backgrounds, although most were not from CALD minorities. Cultural background was determined using a validated scale (one study), self-report (two studies) or not reported (two studies). The design effect from clustering meant an effective minimum sample size of 3164 CALD participants. No meta-analyses were performed. The quality of evidence for each outcome was judged to be low.Two trials comparing cultural competence training with no training found no evidence of effect for treatment outcomes, including the proportion of patients with diabetes achieving LDL cholesterol control targets (risk difference (RD) -0.02, 95% CI -0.06 to 0.02; 1 study, USA, 2699 "black" patients, moderate quality), or change in weight loss (standardised mean difference (SMD) 0.07, 95% CI -0.41 to 0.55, 1 study, USA, effective sample size (ESS) 68 patients, low quality).Health behaviour (client concordance with attendance) improved significantly among intervention participants compared with controls (relative risk (RR) 1.53, 95% CI 1.03 to 2.27, 1 study, USA, ESS 28 women, low quality). Involvement in care by "non-Western" patients (described as "mainly Turkish, Moroccan, Cape Verdean and Surinamese patients") with largely "Western" doctors improved in terms of mutual understanding (SMD 0.21, 95% CI 0.00 to 0.42, 1 study, The Netherlands, 109 patients, low quality). Evaluations of care were mixed (three studies). Two studies found no evidence of effect in: proportion of patients reporting satisfaction with consultations (RD 0.14, 95% CI -0.03 to 0.31, 1 study, The Netherlands, 109 patients, low quality); patient scores of physician cultural competency (SMD 0.11 95% CI -0.63 to 0.85, 1 study, USA, ESS 68 "Caucasian" and "non-Causcasian" patients (described as Latino, African American, Asian and other, low quality). Client perceptions of health professionals were significantly higher in the intervention group (SMD 1.60 95% CI 1.05 to 2.15, 1 study, USA, ESS 28 "Black" women, low quality).No study assessed adverse outcomes.There was no evidence of effect on clinician awareness of "racial" differences in quality of care among clients at a USA health centre (RR 1.37, 95% CI 0.97 to 1.94. P = 0.07) with no adjustment for clustering. Included studies did not measure other outcomes of interest. Sensitivity analyses using different values for the Intra-cluster coefficient (ICC) did not substantially alter the magnitude or significance of summary effect sizes.All four domains of the conceptual framework were addressed, suggesting agreement on core components of cultural competence education interventions may be possible. Cultural competence continues to be developed as a major strategy to address health disparities. Five studies assessed the effects of cultural competence education for health professionals on patient-related outcomes. There was positive, albeit low-quality evidence, showing improvements in the involvement of CALD patients. Findings either showed support for the educational interventions or no evidence of effect. No studies assessed adverse outcomes. The quality of evidence is insufficient to draw generalisable conclusions, largely due to heterogeneity of the interventions in content, scope, design, duration, implementation and outcomes selected.Further research is required to establish greater methodological rigour and uniformity on core components of education interventions, including how they are described and evaluated. Our conceptual framework provides a basis for establishing consensus to improve reporting and allow assessment across studies and populations. Future studies should measure the patient outcomes used: treatment outcomes; health behaviours; involvement in care and evaluations of care. Studies should also measure the impact of these types of interventions on healthcare organisations, as these are likely to affect uptake and sustainability.
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A mental health enterprise may be described by either (a) rather general philosophical total mental health goals, or (b) highly diverse and individualized patient-therapist goals. Goals a. have not provided a workable framework for program evaluation. This paper proposes that evaluation be done in the framework of goals b. by setting up, before treatment, a measurable scale for each patient-therapist goal, and specifying, for each patient, a transformation of his overall goal attainment into a standardized T-score. This method, together with random assignment of patients to treatment modes, was devised to permit comparison of treatment modes within a program, but it also provides a good basis for a judgmental evaluation of the total program.
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Background: We have been investigating an ecologically valid strategy-training approach to enable adults with executive dysfunction to attain everyday life goals. Here, we report the protocol of a randomized controlled trial of the effects of this training compared to conventional therapy in a sample of community-dwelling adults with acquired brain injury and/or stroke. Methods/design: We will recruit 100 community-dwelling survivors at least six months post-acquired brain injury or stroke who report executive dysfunction during a telephone interview, confirmed in pre-training testing. Following pre-training testing, participants will be randomized to the ecologically valid strategy training or conventional therapy and receive two one-hour sessions for eight weeks (maximum of 15 hours of therapy). Post-testing will occur immediately following the training and three months later. The primary outcome is self-reported change in performance on everyday life activities measured using the Canadian Occupational Performance Measure, a standardized, semi-structured interview. Secondary outcomes are objective measurement of performance change from videotapes of treatment session, Performance Quality Rating Scale; executive dysfunction symptoms, Behavioural Rating Inventory of Executive Function - Adult; participation in everyday life, Mayo-Portland Adaptability Inventory Participation Index; and ability to solve novel problems, Instrumental Activities of Daily Living Profile. Discussion: This study is of a novel approach to promoting improvements in attainment of everyday life goals through managing executive dysfunction using an ecologically valid strategy training approach, the Cognitive Orientation to daily Occupational Performance. This study compares the efficacy of this approach with that of conventional therapy. The approach has the potential to be a valuable treatment for people with chronic acquired brain injury and/or stroke. Trial registration: clinicaltrials.gov, Trial Identification Number: NCT01414348.
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To evaluate the effectiveness of goal focused telephone coaching by practice nurses in improving glycaemic control in patients with type 2 diabetes in Australia. Prospective, cluster randomised controlled trial, with general practices as the unit of randomisation. General practices in Victoria, Australia. 59 of 69 general practices that agreed to participate recruited sufficient patients and were randomised. Of 829 patients with type 2 diabetes (glycated haemoglobin (HbA1c) >7.5% in the past 12 months) who were assessed for eligibility, 473 (236 from 30 intervention practices and 237 from 29 control practices) agreed to participate. Practice nurses from intervention practices received two days of training in a telephone coaching programme, which aimed to deliver eight telephone and one face to face coaching episodes per patient. The primary end point was mean absolute change in HbA1c between baseline and 18 months in the intervention group compared with the control group. The intervention and control patients were similar at baseline. None of the practices dropped out over the study period; however, patient attrition rates were 5% in each group (11/236 and 11/237 in the intervention and control group, respectively). The median number of coaching sessions received by the 236 intervention patients was 3 (interquartile range 1-5), of which 25% (58/236) did not receive any coaching sessions. At 18 months' follow-up the effect on glycaemic control did not differ significantly (mean difference 0.02, 95% confidence interval -0.20 to 0.24, P=0.84) between the intervention and control groups, adjusted for HbA1c measured at baseline and the clustering. Other biochemical and clinical outcomes were similar in both groups. A practice nurse led telephone coaching intervention implemented in the real world primary care setting produced comparable outcomes to usual primary care in Australia. The addition of a goal focused coaching role onto the ongoing generalist role of a practice nurse without prescribing rights was found to be ineffective. Current Controlled Trials ISRCTN50662837.
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Background: A health promotion intervention was developed for inflammatory arthritis patients, based on goal management. Elevated levels of depression and anxiety symptoms, which indicate maladjustment, are found in such patients. Other indicators of adaptation to chronic disease are positive affect, purpose in life and social participation. The new intervention focuses on to improving adaptation by increasing psychological and social well-being and decreasing symptoms of affective disorders. Content includes how patients can cope with activities and life goals that are threatened or have become impossible to attain due to arthritis. The four goal management strategies used are: goal maintenance, goal adjustment, goal disengagement and reengagement. Ability to use various goal management strategies, coping versatility and self-efficacy are hypothesized to mediate the intervention's effect on primary and secondary outcomes. The primary outcome is depressive symptoms. Secondary outcomes are anxiety symptoms, positive affect, purpose in life, social participation, pain, fatigue and physical functioning. A cost-effectiveness analysis and stakeholders' analysis are planned. Methods/design: The protocol-based psycho-educational program consists of six group-based meetings and homework assignments, led by a trained nurse. Participants are introduced to goal management strategies and learn to use these strategies to cope with threatened personal goals. Four general hospitals participate in a randomized controlled trial with one intervention group and a waiting list control condition. Discussion: The purpose of this study is to evaluate the effectiveness of a goal management intervention. The study has a holistic focus as both the absence of psychological distress and presence of well-being are assessed. In the intervention, applicable goal management competencies are learned that assist people in their choice of behaviors to sustain and enhance their quality of life. Trial registration: Nederlands Trial Register = NTR3606, registration date 11-09-2012.
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The authors summarize 35 years of empirical research on goal-setting theory. They describe the core findings of the theory, the mechanisms by which goals operate, moderators of goal effects, the relation of goals and satisfaction, and the role of goals as mediators of incentives. The external validity and practical significance of goal-setting theory are explained, and new directions in goal-setting research are discussed. The relationships of goal setting to other theories are described as are the theory’s limitations.
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Regaining independent ambulation is the top priority for individuals recovering from stroke. Thus, physical rehabilitation post-stroke should focus on improving walking function and endurance. However, the amount of walking completed by individuals with stroke attending rehabilitation is far below that required for independent community ambulation. There has been increased interest in accelerometer-based monitoring of walking post-stroke. Walking monitoring could be integrated within the goal-setting process for those with ambulation goals in rehabilitation. The feedback from these devices can be downloaded to a computer to produce reports. The purpose of this study is to determine the effect of accelerometer-based feedback of daily walking activity during rehabilitation on the frequency and duration of walking post-stroke. Participants will be randomly assigned to one of two groups: feedback or no feedback. Participants will wear accelerometers daily during in- and out-patient rehabilitation and, for participants in the feedback group, the participants' treating physiotherapist will receive regular reports of walking activity. The primary outcome measures are the amount of daily walking completed, as measured using the accelerometers, and spatio-temporal characteristics of walking (e.g. walking speed). We will also examine goal attainment, satisfaction with progress towards goals, stroke self-efficacy, and community-integration. Increased walking activity during rehabilitation is expected to improve walking function and community re-integration following discharge. In addition, a focus on altering walking behaviour within the rehabilitation setting may lead to altered behaviour and increased activity patterns after discharge.Trial registration: ClinicalTrials.gov NCT01521234.
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Goal setting is an "open" theory built on inductive findings from empirical research. The present paper briefly summarizes this theory. Emphasis is then given to findings that have been obtained in the present millennium with regard to (1) the high performance cycle, (2) the role of goals as mediators of personality effects on performance, (3) personality variables as moderators of goal effects on performance, the effect of (4) distal, (5) proximal, and (6) learning goals on performance on tasks that are complex for people, (7) the ways in which priming affects the impact of a goal, (8) the interrelationship between goal setting and affect, and (9) the results of goal setting by teams. Potential directions for research on goal setting in the workplace are suggested with regard to goal abandonment, perfectionism, an employee's age, subconscious goals, and the relationship between goals and knowledge.
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Many brain-injured patients referred for outpatient rehabilitation have executive deficits, notably difficulties with planning, problem-solving and goal directed behaviour. Goal Management Training (GMT) has proven to be an efficacious cognitive treatment for these problems. GMT entails learning and applying an algorithm, in which daily tasks are subdivided into multiple steps. Main aim of the present study is to examine whether using an errorless learning approach (preventing the occurrence of errors during the acquisition phase of learning) contributes to the efficacy of Goal Management Training in the performance of complex daily tasks. The study is a double blind randomized controlled trial, in which the efficacy of Goal Management Training with an errorless learning approach will be compared with conventional Goal Management Training, based on trial and error learning. In both conditions 32 patients with acquired brain injury of mixed etiology will be examined. Main outcome measure will be the performance on two individually chosen everyday-tasks before and after treatment, using a standardized observation scale and goal attainment scaling. This is the first study that introduces errorless learning in Goal Management Training. It is expected that the GMT-errorless learning approach will improve the execution of complex daily tasks in brain-injured patients with executive deficits. The study can contribute to a better treatment of executive deficits in cognitive rehabilitation.Trial registration: (Dutch Trial Register): NTR3567.
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Background Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer’s disease, vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. Methods/design In this multi-centre, single-blind randomised controlled trial, 480 people with early-stage dementia, each with a carer, will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months, followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life, self-efficacy, mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. Discussion If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation, it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion. Trial registration Current Controlled Trials ISRCTN21027481
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Techniques to increase physical activity among pulmonary rehabilitation patients outside of the rehabilitation context are warranted. Implementation intentions are a strategy used to initiate goal-directed behaviour, and have been found to be useful in other populations. This study compared the long-term effects of exercise and social implementation intentions interventions on objectively measured physical activity in 40 pulmonary rehabilitation patients randomly assigned to condition. Repeated measures ANOVAs found that those in the exercise implementation intentions group took more steps (p = .007) at the end of pulmonary rehabilitation than those in the social implementation intentions group. Improvements attained by the exercise group during the intervention were not maintained 6-months following rehabilitation. Implementation intentions targeting physical activity appear to have positive short term effects on physical activity, although the long term effects are less consistent. This may be due in part to methods used to assess physical activity behaviour.
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Objective: Tailoring service planning to clients' personal life goals, or person-centered planning, has emerged as a recovery-oriented practice. This study examined the impact of person-centered planning and collaborative documentation on service engagement and medication adherence within community mental health centers (CMHCs). Methods: Ten CMHCs were assigned randomly to receive training in person-centered planning and collaborative documentation or provide usual treatment. Medication adherence and service engagement were measured for 11 months (May 2009-March 2010) for 367 clients. Models compared changes in medication adherence and service engagement among clients of CMHCs in the control and experimental conditions. Results: Medication adherence increased significantly at CMHCs in the experimental condition (B=.022, p≤.01) but showed no significant change at CMHCs in the control condition (B=.004, p=.25). Appointment no-shows at CMHCs in the experimental condition were reduced (odds ratio=.74, p=.001). Conclusions: Person-centered planning and collaborative documentation were associated with greater engagement in services and higher rates of medication adherence.
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The present study examines self-regulation variables (goals, feedback, goal commitment, efficacy, discrepancy) within the context of a brief intervention designed to decrease heavy drinking amongst college females. Participants (N= 76) were randomly assigned to one of six between subjects conditions created by crossing goal conditions (no goal, proximal goal, distal goal) with feedback conditions (feedback, no feedback), and were assessed across time on drinking behavior and self-regulation variables. Neither goal setting, feedback, nor the combination of goal setting and feedback were superior to assessment and information in the reduction of heavy drinking. The interaction of efficacy, commitment and discrepancy failed to add to the prediction of future drinking beyond that accounted for by current drinking behavior and the main effects of self-regulation variables in hierarchical regression analyses. Correlational analyses revealed a negative relationship between efficacy and commitment and future drinking behavior. Results are discussed in relation to theory, the college student environment, and the potential limited efficacy of individual level interventions within this environment.
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Goals and related constructs are ubiquitous in psychological research and span the history of psychology. Research on goals has accumulated sporadically through research programs in cognition, personality, and motivation. Goals are defined as internal representations of desired states. In this article, the authors review the theoretical development of the structure and properties of goals, goal establishment and striving processes, and goal-content taxonomies. They discuss affect as antecedent, consequence, and content of goals and argue for integrating across psychological content areas to study goal-directed cognition and action more efficiently. They emphasize the structural and dynamic aspects of pursuing multiple goals, parallel processing, and the parsimony provided by the goal construct. Finally, they advocate construct validation of a taxonomy of goals. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Background: Little research has been carried out on the effects of involving patients in goal setting. The purpose of this study was to investigate the effects of active patient involvement in the establishment of physical therapy treatment goals. Outcome measures included both physical treatment results and patient ratings of the quality of care. Subjects and Methods: All patients (n=77) at the rehabilitation unit of the department of rheumatology at a Swedish university hospital were included in a randomized controlled trial. Control-group patients received physical therapy treatment according to traditional methods. Intervention-group patients were involved in a goal-forum intervention, where therapist and patient together established goals for treatment. All patients completed questionnaire surveys at discharge. Results: Stepwise logistic regression analysis revealed that patients in the intervention group were more likely to achieve better physical treatment results for range of motion, strength and balance, compared to controls. Goal-forum patients also gave higher ratings than the control group on quality of care scales. Discussion and Conclusion: Active patient involvement in establishing physical therapy goals may have beneficial effects on both treatment outcomes and patient ratings of the quality of care. Further studies involving more physical therapists and longer follow-up periods are warranted.
Chapter
There is growing acknowledgement that scientific progress in rehabilitation requires development of theories in addition to empirical research (Dunn & Elliot, 2008; Siegert, McPherson, & Dean, 2005; Siegert & Taylor, 2004). While a grand unified theory of rehabilitation seems highly unlikely to emerge, there is increasing acceptance that sophisticated theoretical accounts of important phenomena in rehabilitation are necessary to understand complex processes and predict outcomes (Scobbie, Wyke, & Dixon, 2009; Siegert, McPherson, & Taylor, 2004; Whyte, 2007). This awareness of the important role of theory building and theory testing in a scientific rehabilitation is a recent development. Rehabilitation theory of goal setting still lags well behind goal-setting research in fields such as industrial-organizational psychology, education and sport psychology. This imbalance between theory development and empirical research limits the scientific credibility of rehabilitation (Siegert et al., 2005). More importantly, it does our clients or patients a disservice. It assumes that all we need is evidence about which interventions are effective - without a comprehensive understanding of how an intervention works for an individual client with a particular set of problems in a unique psychosocial context.
Conference Paper
Objectives: Prospective memory, the ability to realise delayed intentions, is particularly susceptible to the effects of brain injury and therefore an important target for rehabilitation efforts. Implementation Intentions (II) have been shown to improve performance on prospective memory tasks across a variety of durations, by circumventing controlled attention and establishing strong cue-action associations using imagery and declarative statements. This technique has not been evaluated in people with a brain injury. The objective of the study was to compare an intervention combining Goal Management Training with Implementation Intentions, with a control intervention involving Goal Management Training and an imagery strategy. Methods: A single-blind randomised trial was used, involving a 2x2 within-between design. 21 participants were randomised to intervention group and blinded to their allocation. Pre- and post-intervention assessment used an ecologically valid measure of executive function (JAAM virtual reality task), which inculdes measures of prospective memory. Results: Both the experimental and control groups improved on the primary outcome measure, but there was no significant difference in improvement between the groups. Use of baseline performance, estimated pre-morbid intelligence, depression and processing speed as covariates did not result in significant changes to the effectiveness of the interventions. Conclusions: The lack of treatment effect may be attributable to several factors, including lack of lack of treament efficacy, but also the interaction between severity of impairment, length of training and complexity of the outcome measure. The appropriateness of group designs when assessing neuropsychological rehabilitation interventions of this type is also discussed.