A theory-based goal setting practice framework for use in rehabilitation settings is described. The framework requires further development and systematic evaluation in a range of rehabilitation settings.

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There is large variation in patients' pre-operative expectations of THR. Greater numbers of pre-operative expectations were associated with improvement following THR. This appears to be driven more by stiffness and function. These findings have implications for informed patient-clinician decision-making.

BackgroundGoal setting is considered ‘best practice’ in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke.MethodsG-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation.ResultsG-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient’s well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process.ConclusionsG-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings.

In this study, the authors examined the factor structure and temporal stability of the Child and Adolescent Perfectionism Scale (CAPS; G.

The DCV method allowed quantitative assessment of each item and can therefore inform the content validity of the measures assessed. The methods can be applied to assess content validity before or after collecting data to select the appropriate items to measure theoretical constructs. Further, the data reported for each item in Appendix S1 can be used in item or measure selection. Statement of contribution What is already known on this subject? There are agreed methods of assessing and reporting construct validity of measures of theoretical constructs, but not their content validity. Content validity is rarely reported in a systematic and transparent manner. What does this study add? The paper proposes discriminant content validity (DCV), a systematic and transparent method of assessing and reporting whether items assess the intended theoretical construct and only that construct. In three studies, DCV was applied to measures of illness perceptions, control cognitions, and theory of planned behaviour response formats. Appendix S1 gives content validity indices for each item of each questionnaire investigated. Discriminant content validity is ideally applied while the measure is being developed, before using to measure the construct(s), but can also be applied after using a measure.

Background: The International Classification of Functioning, Disability and Health (ICF) model of the consequences of disease identifies three health outcomes, impairment, activity limitations and participation restrictions. However, few orthopaedic health outcome measures were developed with reference to the ICF. This study examined the ability of a valid and frequently used measure of upper limb function, namely the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), to operationalise the ICF.

Objectives: To investigate how best to encourage health professionals to promote, and for people with asthma to use, asthma action plans.Methods: Systematic review. Randomised controlled trials published between 1960 and 2006 were searched using multiple electronic databases. Unpublished and ongoing studies were identified by contacting asthma experts internationally. Included trials reported outcome data for the promotion of action plans including issue of plans by health professionals, and patient ownership and use.Results: 14 trials satisfied our study inclusion criteria. Of these, only four studies reported data for action plan use. Interventions included: education of doctors and people with asthma; telephone reinforcement; partially completed action plans and postal prompts inviting patients for general practice review; school asthma clinics; and asthma management systems (including the 3+ plan with patient recall for review and Internet-based physician monitoring). These interventions increased action plan ownership, use, or facilitation of use. Two of the highest quality papers were conducted in primary care and demonstrate the effectiveness of interventions directed at the organisation of asthma care in promoting action plan use.Conclusions: Primary care professionals could encourage the ownership and use of action plans through the implementation of proactive practice-based organisational systems, though further research is required to assess their practicality and effect on sustaining use long-term. Multi-disciplinary teams working in areas where asthma action plan ownership and use is sub-optimal should therefore consider how such interventions could be incorporated into existing practices and healthcare systems.