Goal setting in neurological rehabilitation: Staff perspectives

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


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

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    • "There are many benefits to collaborative goal setting, including encouraging active participation of the patient in their management, providing shared outcomes for clinicians and patients to work towards, and facilitating patients to become more self-determining121314151617. However, there are inconsistencies in its use amongst clinicians, and there is no defined approach for collaboration[6,18192021. Patients also need to want, and be able, to participate in the process[8,22,23]. "
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    ABSTRACT: Collaborative goal setting is an integral component of treatment planning for adults with neuromuscular disorders (NMD). However, due to the unique challenges for these individuals, identifying a process for goal setting that is advantageous for all can be problematic. This study aimed to evaluate collaborative goal setting at a specialist NMD centre, as reported by service users attending physiotherapy. It also aimed to generate discussion about collaborative goal setting and the practice of goal setting in adults with NMD in order to inform future practice.
    No preview · Article · Dec 2015 · Physiotherapy
    • "Other challenges to goal setting with individuals with brain injury are reported. These include assumptions by the clinician that individuals with resultant cognitive and communication impairments are not capable of participating in goal setting, lack of client knowledge about goals, lack of clinician experience, and organization factors that constrain client inclusion such as caseload demands and lack of time (Barnard et al., 2010; Holliday et al., 2005; Playford, Siegert, Levack, & Freeman, 2009; Trentham & Dunal, 2009; Van De Weyer et al., 2010). These challenges have contributed to routine lack of inclusion of clients with brain injury in clinical goal setting (Holliday et al., 2005). "
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    ABSTRACT: For individuals with brain injury, active participation in goal setting is associated with better rehabilitation outcomes. However, clinicians report difficulty engaging these clients in goal setting due to perceived or real deficits (e.g., lack of awareness). We conducted a study using grounded theory methods to understand how clinicians from occupational therapy facilitate client engagement and manage challenges inherent in goal setting with this population. Through constant comparative analysis, a goal-setting continuum emerged. At one end of the continuum, therapists embrace client-determined goals and enable clients to decide their own goals. At the other, therapists accept preset organizationdetermined goals (e.g., “the goal is discharge”) and pay little attention to client input. Although all participants aspired to embrace client-determined goal setting, most felt powerless to do so within perceived organizational constraints. Views of advocacy and empowerment help to explain our findings and inform more inclusive practice.
    No preview · Article · Aug 2015 · Qualitative Health Research
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    • "We found that some participants reported difficulties with articulating specific rehabilitation goals, and that health professionals experienced that goal setting could be a challenging in HD. Goal setting is a core skill of rehabilitation professionals, and is considered as an essential component of any modern approach to rehabilitation [21, 22]. Studies suggest that patients’ experience of the rehabilitation process is significantly better, and that the nature of rehabilitation goals changes when patients are involved in goal setting [23]. "
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    ABSTRACT: Background Research suggests that rehabilitation is beneficial for persons with Huntington’s disease (HD), but there is limited knowledge about participants’ experiences with residential rehabilitation programs. We therefore did a study to explore patients’, family caregivers’, and health professionals’ experiences with a group-based, residential rehabilitation program for individuals with early to mid-stage HD, focusing on three research questions: How did participants experience the structure and content of the program? What outcomes did patients experience? What challenges and success factors did health professionals report? Methods Qualitative, explorative study, collecting data through in-depth interviews with nine family caregivers and 11 patients with early- and mid-stage HD, and focus group interviews with 15 health professionals. Data were analysed using systematic text condensation. Results Some participants reported difficulties with defining individual rehabilitation goals, but written individualised plans and schedules were appreciated by all participants. Participants highlighted being member of an "HD-group" as a valuable experience, though tensions and conflicts could occur in groups. Participants typically reported improved gait and balance, increased self-confidence, and social benefits as outcomes. The intensive schedule was acceptable for most participants, but adjustments had been made to allow participants more time to eat, shower and dress between sessions. Success factors reported by health professionals were assigning every patient with a contact person, using clinical tests results to motivate patients, and supervising health professionals in patients’ local municipalities. Conclusions Group-based residental rehabilitation was feasible for individuals with early- and mid-stage HD, and participants emphasised mental and social outcomes in addition to physical outcomes. The needs of persons with HD should be considerd when designing programs, to secure structure, continuity in personnel, and sufficient time between sessions.
    Full-text · Article · Sep 2014 · BMC Health Services Research
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