Goal Setting in Rehabilitation: Difference between revisions
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== Introduction == | == Introduction == | ||
Goal setting between physiotherapists and their patients or clients is a fundamental part of rehabilitation. Goal setting is “the formal process whereby a rehabilitation professional or team together with the patient and/or their family negotiate goals.” ( | Goal setting between physiotherapists and their patients or clients is a fundamental part of rehabilitation. Goal setting is “the formal process whereby a rehabilitation professional or team together with the patient and/or their family negotiate goals.”<ref name=":0">Wade P. Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil [Internet]. 2009 Apr;23(4):291-5 http://journals.sagepub.com/doi/abs/10.1177/0269215509103551 (accessed 20 July 2018)</ref> | ||
Goal setting is used to direct rehabilitation interventions towards a specific outcome or outcomes. Shared goal setting can also co-ordinate members of the multidisciplinary team and ensure they are working together towards a common goal and that nothing important is missed | Goal setting is used to direct rehabilitation interventions towards a specific outcome or outcomes. Shared goal setting can also co-ordinate members of the multidisciplinary team and ensure they are working together towards a common goal and that nothing important is missed<ref name=":0" />. Goals can also be used to evaluate the success of rehabilitation interventions (Wade 2009). | ||
There is no consensus on a gold standard for a method of goal setting but it is widely held that it is a priority for guiding rehabilitation interventions toward achievable and meaningful outcomes3. There is a growing body of literature dedicated to the methods of and evidence | There is no consensus on a gold standard for a method of goal setting but it is widely held that it is a priority for guiding rehabilitation interventions toward achievable and meaningful outcomes3. There is a growing body of literature dedicated to the methods of and evidence for<ref name=":0" /><ref name=":1">Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil. 2011. 25(6): 501-514. Available from [http://journals.sagepub.com/doi/abs/10.1177/0269215510394467 http://journals.sagepub.com/doi/abs/10.1177/026921551039446725, Issue 6, pp. 501 - 514]. Accessed 28 June 2018. </ref><ref name=":2">Bouwens SFM, van Heugten CM, Verhey FRJ. The practical use of goal attainment scaling for people with acquired brain injury who receive cognitive rehabilitation. Clin Rehabil 2009 23 (4):310 - 320. http://journals.sagepub.com/doi/abs/10.1177/0269215508101744 (accessed 17 July 2018).</ref> goal setting in rehabilitation. | ||
== The Basics of Goal Setting == | == The Basics of Goal Setting == | ||
Goal setting is based on the belief that humans can change their behaviour and work towards a goal | Goal setting is based on the belief that humans can change their behaviour and work towards a goal<ref>Scobbie L, Wyke S, Dixon D. Identifying and applying psychological theory to setting and achieving rehabilitation goals: development of a practice framework. Clin Rehabil 2009; 23 (4): 321-333. ISSN 0269-2155. https://strathprints.strath.ac.uk/20128/ (accessed 17 July 2018).</ref>. | ||
Goal setting is important for rehabilitation because it can provide the patient with motivation | Goal setting is important for rehabilitation because it can provide the patient with motivation <ref name=":0" />. A meaningful goal can motivate a patient to participate in rehabilitation in order to achieve their goals. For example, the elderly patient in rehabilitation following a hip replacement who wants to return to living independently in their own home with their spouse. In order to do this, the patient needs to be independently mobile and therefore can see the importance of participating in physiotherapy. | ||
Goals can be thought of | Goals can be thought of as hierarchical<ref>Maslow AH. A Theory of Human Motivation. Originally published in Psychological Review 1943; 50, 370-396. Accessed from Green, CD. Classics in the History of Psychology [Internet] 2000<nowiki/>https://psychclassics.yorku.ca/Maslow/motivation.htm (accessed 25 July 2018).</ref> . Maslow suggested that a person will make their physiological needs their primary goals. Once a person has met their physiological needs, he or she will make goals at the next level, safety and security, and so on. See Diagram One for all levels. | ||
[[File:Maslow's hierarchy of needs.svg.png|alt=Diagram One: Maslow's Hierarchy of Needs|thumb]] | [[File:Maslow's hierarchy of needs.svg.png|alt=Diagram One: Maslow's Hierarchy of Needs|thumb]] | ||
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Goal setting is the process of discussing, planning and documenting outcomes for a patient. It can be as simple as a conversation between a physiotherapist and a patient during a treatment session. Or, in can be more complex and structured in a meeting between a multidisciplinary team and a patient. The patient’s social supports, e.g family members or friends, may also be invited to join in with goal setting if they have a role to play in helping the patient achieve a particular goal. | Goal setting is the process of discussing, planning and documenting outcomes for a patient. It can be as simple as a conversation between a physiotherapist and a patient during a treatment session. Or, in can be more complex and structured in a meeting between a multidisciplinary team and a patient. The patient’s social supports, e.g family members or friends, may also be invited to join in with goal setting if they have a role to play in helping the patient achieve a particular goal. | ||
One common method of goal setting has been derived from SMART goals. SMART goals originated in the field of project management ( | One common method of goal setting has been derived from SMART goals. SMART goals originated in the field of project management<ref>Doran GT. There’s a S.M.A.R.T. Way to Write Management’s Goals and Objectives. Management Review. 1981; 70: 35-36.https://community.mis.temple.edu/mis0855002fall2015/files/2015/10/S.M.A.R.T-Way-Management-Review.pdf (accessed 25 July 2018).</ref>. There are some variations but in general the acronym stands for: | ||
'''S''' Specific | '''S''' Specific | ||
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'''T''' Time-related | '''T''' Time-related | ||
Another system which is grounded in rehabilitation research is the goal attainment scaling (GAS) by | Another system which is grounded in rehabilitation research is the goal attainment scaling (GAS) by Turner-Stokes<ref name=":3">Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009; 23 (4); 362-370. http://journals.sagepub.com/doi/abs/10.1177/0269215508101742 (accessed 26 July 2018). | ||
</ref> . GAS is “a mathematical technique for quantifying the achievement of goals”<ref name=":3" />. GAS describes a process for setting goals and uses a five-point scale to measure how the goal is achieved or not. GAS scores can then be aggregated. Individual scores can be weighted to reflect either the relative importance of a goal to the patient or health professional or the difficulty in achieving the goal. | |||
There are some factors which can facilitate or create barriers to successful goal setting. See Table One. | There are some factors which can facilitate or create barriers to successful goal setting. See Table One. | ||
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|Time | |Time | ||
|Facilitator or barrier | |Facilitator or barrier | ||
|Playford et al | |Playford et al <ref name=":4">Playford ED, Siegert R, Levack W, Freeman J. Areas of consensus and controversy about goal setting in rehabilitation: a conference report. Clin Rehabil. 2009. 23(4): 334-344.http://journals.sagepub.com/doi/abs/10.1177/0269215509103506. Accessed 27 June 2018. </ref> | ||
|- | |- | ||
|Social supports | |Social supports | ||
|Family and friends may help or hinder | |Family and friends may help or hinder | ||
|Alanko et al | |Alanko et al <ref name=":5">Alanko T, Karhula M, Kröger T, Piirainen A, Nikander R. Rehabilitees perspective on goal setting in rehabilitation – a phenomenological approach. Disabil Rehabil. 2018. DOI: [https://doi.org/10.1080/09638288.2018.1463398 10.1080/09638288.2018.1463398]. Published online at https://www.tandfonline.com/doi/abs/10.1080/09638288.2018.1463398.</ref> | ||
|- | |- | ||
|Pain | |Pain | ||
|Barrier | |Barrier | ||
|Alanko et al | |Alanko et al <ref name=":5" /> | ||
|- | |- | ||
|Health professionals’ expertise or lack of | |Health professionals’ expertise or lack of | ||
|Facilitator or barrier | |Facilitator or barrier | ||
|Playford et al | |Playford et al <ref name=":4" /><ref>Plant SE, Tyson SF, Kirk S, Parsons J. What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis. Clin Rehabil. 2016. 30(9): 921-930. Available from http://journals.sagepub.com/doi/pdf/10.1177/0269215516655856. Accessed 27 June 2018. </ref> | ||
|- | |- | ||
|Cognition | |Cognition | ||
|Barrier | |Barrier | ||
|Bouwens et al | |Bouwens et al <ref name=":2" /> | ||
|- | |- | ||
|The patient’s self awareness | |The patient’s self awareness | ||
|Facilitator or barrier | |Facilitator or barrier | ||
|Fischer et al | |Fischer et al <ref>Fischer S, Gauggel S, Trexler LE. Awareness of activity limitations, goal setting and rehabilitation outcome in patients with brain injuries, Brain Inj. 2004;18:6, 547-562. https://www.tandfonline.com/doi/abs/10.1080/02699050310001645793 (accessed 25 July 2018).</ref> | ||
|- | |- | ||
|Patient involvement | |Patient involvement | ||
| | |Facilitator or barrier | ||
|Evans | |Evans <ref>Evans JJ. Goal setting during rehabilitation early and late after acquired brain injury. Curr Opin Neurol. 2012;25(6):651-5. https://www.ncbi.nlm.nih.gov/pubmed/23007008 (accessed 25 July 2018).</ref><ref>Barnard RA, Cruice, MN, Playford ED. Strategies Used in the Pursuit of Achievability During Goal Setting in Rehabilitation. Qual Health Res. 2010. 20(2): 239-250. Available from http://journals.sagepub.com/doi/abs/10.1177/1049732309358327 </ref> | ||
|- | |- | ||
|Patient’s desire to pursue goals and modify as needed | |Patient’s desire to pursue goals and modify as needed | ||
|Facilitator | |Facilitator | ||
|Coffey et al | |Coffey et al <ref name=":6">Coffey L, Gallagher P, Desmond D. Goal Pursuit and Goal Adjustment as Predictors of Disability and Quality of Life Among Individuals With a Lower Limb Amputation: A Prospective Study. Arch Phys Med Rehabil. 2014; 95 (2): 244-252.https://www.sciencedirect.com/science/article/pii/S0003999313006230 (accessed 29 July 2018). | ||
</ref> | |||
|} | |} | ||
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|'''Main Results''' | |'''Main Results''' | ||
|- | |- | ||
|Bouwens et | |Bouwens et al<ref name=":2" /> | ||
|2009 | |2009 | ||
|Acquired brain injury | |Acquired brain injury | ||
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|It is possible to set three realistic goals per patient withing 30 minutes. Goals were set in cognitive and behavioural domains | |It is possible to set three realistic goals per patient withing 30 minutes. Goals were set in cognitive and behavioural domains | ||
|- | |- | ||
|Rosewilliam et | |Rosewilliam et al<ref name=":1" /> | ||
|2011 | |2011 | ||
|Stroke | |Stroke | ||
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|Nominal adoption of goals setting, discrepancies between perceptions and practice of goal setting, related ethical conflicts, strategies to improve goal setting, weak methodologies, some improvement in psychological outcomes, further research needed. | |Nominal adoption of goals setting, discrepancies between perceptions and practice of goal setting, related ethical conflicts, strategies to improve goal setting, weak methodologies, some improvement in psychological outcomes, further research needed. | ||
|- | |- | ||
|Coffey et | |Coffey et al<ref name=":6" /> | ||
|2014 | |2014 | ||
|Lower limb amputation | |Lower limb amputation | ||
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|High levels of disability in this population. QoL stable over first six months. Stronger goal pursuit and goal adjustment tendencies predicted lower disability and higher QoL six months post discharge | |High levels of disability in this population. QoL stable over first six months. Stronger goal pursuit and goal adjustment tendencies predicted lower disability and higher QoL six months post discharge | ||
|- | |- | ||
|Alanko et | |Alanko et al<ref name=":5" /> | ||
|2018 | |2018 | ||
|Stroke and back pain | |Stroke and back pain | ||
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[[Re-engagement in Life Roles with Pain Conditions]] | [[Re-engagement in Life Roles with Pain Conditions]] | ||
== References == | == References == | ||
<references /> | <references /> |
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Introduction[edit | edit source]
Goal setting between physiotherapists and their patients or clients is a fundamental part of rehabilitation. Goal setting is “the formal process whereby a rehabilitation professional or team together with the patient and/or their family negotiate goals.”[1]
Goal setting is used to direct rehabilitation interventions towards a specific outcome or outcomes. Shared goal setting can also co-ordinate members of the multidisciplinary team and ensure they are working together towards a common goal and that nothing important is missed[1]. Goals can also be used to evaluate the success of rehabilitation interventions (Wade 2009).
There is no consensus on a gold standard for a method of goal setting but it is widely held that it is a priority for guiding rehabilitation interventions toward achievable and meaningful outcomes3. There is a growing body of literature dedicated to the methods of and evidence for[1][2][3] goal setting in rehabilitation.
The Basics of Goal Setting[edit | edit source]
Goal setting is based on the belief that humans can change their behaviour and work towards a goal[4].
Goal setting is important for rehabilitation because it can provide the patient with motivation [1]. A meaningful goal can motivate a patient to participate in rehabilitation in order to achieve their goals. For example, the elderly patient in rehabilitation following a hip replacement who wants to return to living independently in their own home with their spouse. In order to do this, the patient needs to be independently mobile and therefore can see the importance of participating in physiotherapy.
Goals can be thought of as hierarchical[5] . Maslow suggested that a person will make their physiological needs their primary goals. Once a person has met their physiological needs, he or she will make goals at the next level, safety and security, and so on. See Diagram One for all levels.
Goal setting is also important as it keeps the focus of rehabilitation patient-centred. Goal setting helps health professionals plan their interventions for what is best or most meaningful for the patient instead of what suits the health professionals (where there are differences).
Goals can be defined by time e.g. short, medium or long-term. In physiotherapy, goals are often activity based. For example, a patient being able to do a functional task independently or being able to walk a certain distance with the aid of walking frame.
Goal Setting Methods[edit | edit source]
Goal setting is the process of discussing, planning and documenting outcomes for a patient. It can be as simple as a conversation between a physiotherapist and a patient during a treatment session. Or, in can be more complex and structured in a meeting between a multidisciplinary team and a patient. The patient’s social supports, e.g family members or friends, may also be invited to join in with goal setting if they have a role to play in helping the patient achieve a particular goal.
One common method of goal setting has been derived from SMART goals. SMART goals originated in the field of project management[6]. There are some variations but in general the acronym stands for:
S Specific
M Measurable
A Attainable or Assignable
R Realistic
T Time-related
Another system which is grounded in rehabilitation research is the goal attainment scaling (GAS) by Turner-Stokes[7] . GAS is “a mathematical technique for quantifying the achievement of goals”[7]. GAS describes a process for setting goals and uses a five-point scale to measure how the goal is achieved or not. GAS scores can then be aggregated. Individual scores can be weighted to reflect either the relative importance of a goal to the patient or health professional or the difficulty in achieving the goal.
There are some factors which can facilitate or create barriers to successful goal setting. See Table One.
Table One: Factors Influencing Goal Setting
Factor | Influence | Evidence |
Time | Facilitator or barrier | Playford et al [8] |
Social supports | Family and friends may help or hinder | Alanko et al [9] |
Pain | Barrier | Alanko et al [9] |
Health professionals’ expertise or lack of | Facilitator or barrier | Playford et al [8][10] |
Cognition | Barrier | Bouwens et al [3] |
The patient’s self awareness | Facilitator or barrier | Fischer et al [11] |
Patient involvement | Facilitator or barrier | Evans [12][13] |
Patient’s desire to pursue goals and modify as needed | Facilitator | Coffey et al [14] |
Evidence For Goal Setting[edit | edit source]
Author | Date | Population | n= | Intervention | Outcome Measure | Main Results |
Bouwens et al[3] | 2009 | Acquired brain injury | 48 | Cognitive rehabilitation programme | Goal Attainment Scaling, number of goals made, time to set goals, domains in which goals were set | It is possible to set three realistic goals per patient withing 30 minutes. Goals were set in cognitive and behavioural domains |
Rosewilliam et al[2] | 2011 | Stroke | Not applicable | Systematic review of 18 qualitative studies, eight quantitative studies and one mixed methods study | Not applicable | Nominal adoption of goals setting, discrepancies between perceptions and practice of goal setting, related ethical conflicts, strategies to improve goal setting, weak methodologies, some improvement in psychological outcomes, further research needed. |
Coffey et al[14] | 2014 | Lower limb amputation | 64 | Not applicable | WHODAS 2.0, WHO-QOL-BREF,
Tenacious Goal Pursuit Scale, Flexible Goal Adjustment Scale |
High levels of disability in this population. QoL stable over first six months. Stronger goal pursuit and goal adjustment tendencies predicted lower disability and higher QoL six months post discharge |
Alanko et al[9] | 2018 | Stroke and back pain | 20 | Not applicable | Qualitative interviews and analysis of rehabilitees perspectives on goal setting in rehabilitation | Five meanings:
1) “trust in the rehabilitation situation, professionals, oneself and relatives” 2) “respectful presence” 3) “confusing awareness” 4) “disturbing pain” 5) “fear of unpredictability” |
Practical Points to Remember[edit | edit source]
- Use goals to guide and evaluate your physiotherapy treatments.
- Discuss, plan and review goals for rehabilitation with your patient.
- Discuss, plan and review goals for rehabilitation with other members of your multidisciplinary team (if applicable).
- Use a method such as SMART or GAS and document the goals made with a date to review them and check for progress.
Related Physiopedia Pages[edit | edit source]
Multidisciplinary/interdisciplinary management of the amputee
Re-engagement in Life Roles with Pain Conditions
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Wade P. Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil [Internet]. 2009 Apr;23(4):291-5 http://journals.sagepub.com/doi/abs/10.1177/0269215509103551 (accessed 20 July 2018)
- ↑ 2.0 2.1 Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil. 2011. 25(6): 501-514. Available from http://journals.sagepub.com/doi/abs/10.1177/026921551039446725, Issue 6, pp. 501 - 514. Accessed 28 June 2018.
- ↑ 3.0 3.1 3.2 Bouwens SFM, van Heugten CM, Verhey FRJ. The practical use of goal attainment scaling for people with acquired brain injury who receive cognitive rehabilitation. Clin Rehabil 2009 23 (4):310 - 320. http://journals.sagepub.com/doi/abs/10.1177/0269215508101744 (accessed 17 July 2018).
- ↑ Scobbie L, Wyke S, Dixon D. Identifying and applying psychological theory to setting and achieving rehabilitation goals: development of a practice framework. Clin Rehabil 2009; 23 (4): 321-333. ISSN 0269-2155. https://strathprints.strath.ac.uk/20128/ (accessed 17 July 2018).
- ↑ Maslow AH. A Theory of Human Motivation. Originally published in Psychological Review 1943; 50, 370-396. Accessed from Green, CD. Classics in the History of Psychology [Internet] 2000https://psychclassics.yorku.ca/Maslow/motivation.htm (accessed 25 July 2018).
- ↑ Doran GT. There’s a S.M.A.R.T. Way to Write Management’s Goals and Objectives. Management Review. 1981; 70: 35-36.https://community.mis.temple.edu/mis0855002fall2015/files/2015/10/S.M.A.R.T-Way-Management-Review.pdf (accessed 25 July 2018).
- ↑ 7.0 7.1 Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009; 23 (4); 362-370. http://journals.sagepub.com/doi/abs/10.1177/0269215508101742 (accessed 26 July 2018).
- ↑ 8.0 8.1 Playford ED, Siegert R, Levack W, Freeman J. Areas of consensus and controversy about goal setting in rehabilitation: a conference report. Clin Rehabil. 2009. 23(4): 334-344.http://journals.sagepub.com/doi/abs/10.1177/0269215509103506. Accessed 27 June 2018.
- ↑ 9.0 9.1 9.2 Alanko T, Karhula M, Kröger T, Piirainen A, Nikander R. Rehabilitees perspective on goal setting in rehabilitation – a phenomenological approach. Disabil Rehabil. 2018. DOI: 10.1080/09638288.2018.1463398. Published online at https://www.tandfonline.com/doi/abs/10.1080/09638288.2018.1463398.
- ↑ Plant SE, Tyson SF, Kirk S, Parsons J. What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis. Clin Rehabil. 2016. 30(9): 921-930. Available from http://journals.sagepub.com/doi/pdf/10.1177/0269215516655856. Accessed 27 June 2018.
- ↑ Fischer S, Gauggel S, Trexler LE. Awareness of activity limitations, goal setting and rehabilitation outcome in patients with brain injuries, Brain Inj. 2004;18:6, 547-562. https://www.tandfonline.com/doi/abs/10.1080/02699050310001645793 (accessed 25 July 2018).
- ↑ Evans JJ. Goal setting during rehabilitation early and late after acquired brain injury. Curr Opin Neurol. 2012;25(6):651-5. https://www.ncbi.nlm.nih.gov/pubmed/23007008 (accessed 25 July 2018).
- ↑ Barnard RA, Cruice, MN, Playford ED. Strategies Used in the Pursuit of Achievability During Goal Setting in Rehabilitation. Qual Health Res. 2010. 20(2): 239-250. Available from http://journals.sagepub.com/doi/abs/10.1177/1049732309358327
- ↑ 14.0 14.1 Coffey L, Gallagher P, Desmond D. Goal Pursuit and Goal Adjustment as Predictors of Disability and Quality of Life Among Individuals With a Lower Limb Amputation: A Prospective Study. Arch Phys Med Rehabil. 2014; 95 (2): 244-252.https://www.sciencedirect.com/science/article/pii/S0003999313006230 (accessed 29 July 2018).