Goal statements in brain injury rehabilitation: A cohort study of client-centredness and relationship with goal outcome

Abstract

Background:Currently, there is increasing recognition of the need to use a client-centred approach to goal setting in rehabilitation. However, there is limited research to guide practice with community-dwelling clients with acquired brain injury. An understanding of the characteristics of client-centred goals and the extent to which client-centeredness influences goal outcomes is required.Objective:To examine the relationships between the client-centredness of goals and their characteristics, content, recall and outcomes of client-centred goals in brain injury rehabilitation.Methods:A prospective cohort design study was employed. Participants were 45 clients with brain injury receiving outpatient rehabilitation, who completed measures of client-centredness after goal setting. Each goal was classified according to whether it was specific, measurable, non-jargonistic, and participation-focussed, included a timeframe and was recalled by participants.Results:Participants set 223 goals with 20 clinicians from multiple disciplines. Levels of client-centredness did not differ according to the characteristics, content and recall of goals, with the exception of goal specificity (p < 0.01). Client-centredness was significantly and positively correlated with goal outcomes (p < 0.05).Conclusions:The use of client-centred goals is recommended for improved rehabilitation outcomes. Applying goal documentation criteria does not necessarily mean that goals will be client-centred, and highly specific goal statements may not reflect what is important and meaningful to clients.

Person-Centered Rehabilitation Model: Framing the Concept and Practice of Person-Centered Adult Physical Rehabilitation Based on a Scoping Review and Thematic Analysis of the Literature

“…39,49,72,78,124,128,131,134 PCR approaches are open to exploring the experiences and perceptions of disability, how meaningful lives can be (re)constructed, and how rehabilitation can be instrumental for that. 39,138 PCR interactions provide persons with the opportunities and empathetic encouragement for supported self-explorations, as much as the person wants, to addressing issues such as one's life story, situation, life goals, or occupational choices. 23,31,39,47,49,57,72,77,84,99,112,117,118,131,134,138 This helps to frame impairments within a continuum of life changes, link one's past and present to hopes for a meaningful future, and foster the person's capacity to envision relevant life goals and agency-based paths toward their achievement.…”

“…39,138 PCR interactions provide persons with the opportunities and empathetic encouragement for supported self-explorations, as much as the person wants, to addressing issues such as one's life story, situation, life goals, or occupational choices. 23,31,39,47,49,57,72,77,84,99,112,117,118,131,134,138 This helps to frame impairments within a continuum of life changes, link one's past and present to hopes for a meaningful future, and foster the person's capacity to envision relevant life goals and agency-based paths toward their achievement. 21,22,28,39,51,66,69,72,75,77,80,84,92,99,110,116,123,124,127,131 Self-exploration can be supported by narrative, storytelling approaches, 77,85,121,139,140 including exploration of life in retrospect or teleologically 84 or by using tools that identify issues of personal relevance (eg, Canadian Occupational Performance Measure),…”

“…26,49,87,92,100,112,115,137,149 Furthermore, PCR goals, plans, or their development are not necessarily formulaic. 83,100,128,138 Some persons find that far-reaching or general goal statements, worded into "relaxed" or colloquial language, 55 are more personcentered than short-term, specific goals designed to be measurable, which are sometimes understood as service-oriented. 33,123,129,138,150 From a PCR perspective, meaningful changes are not necessarily numerically based but experienced by the person.…”

“…83,100,128,138 Some persons find that far-reaching or general goal statements, worded into "relaxed" or colloquial language, 55 are more personcentered than short-term, specific goals designed to be measurable, which are sometimes understood as service-oriented. 33,123,129,138,150 From a PCR perspective, meaningful changes are not necessarily numerically based but experienced by the person. 92,102 Yet, varying goal-setting approaches work differently for different persons 55,81,83,123,128,149 ; the balance between flexible, open-ended approaches and formal, structured ones has to be found for each person.…”

Theoretical proposal for therapy planning in vocal practice: a ICF model application

“…Además, el modelo se ajusta adecuadamente al planteamiento de objetivos bajo la lógica del modelo de la CIF (Bovend'Eerdt et al, 2009). Actualmente, a nivel internacional, la propuesta SMART ha sido incorporada en el abordaje tanto fonoaudiológico como de las otras ciencias de la rehabilitación (Angeli et al, 2018(Angeli et al, , 2019Bailey, 2017;Bowman et al, 2015;Fu et al, 2020;Hersh et al, 2012;Prescott et al, 2019;Řasová et al, 2020).…”