Ready for goal setting? Process evaluation of a patient-specific goal-setting method in physiotherapy

Abstract

BackgroundPatient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method.MethodsWe conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports.ResultsData were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the ‘setting goals’ and ‘planning treatment’ steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour.ConclusionThe PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting process. However, its full potential for shared goal setting has not been utilized yet. More implementation effort is needed to achieve the required behaviour change and a truly client-centred attitude, to make physiotherapists totally ready for shared goal setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2557-9) contains supplementary material, which is available to authorized users.

Limited predictive value of illness perceptions for short-term poor recovery in musculoskeletal pain. A multi-center longitudinal study

“… Physical functioning (PF) Difficulty in performing daily activities (11-point Patient-Specific Functional Scale (PSFS): 0 = no difficulty; 10 = unable to perform the activity). The PSFS is reportedly feasible and reliable [ 20 , 21 ]. Pain duration Patients rated how long their pain had existed prior to consultation: 1: pain < 7 weeks; 2: pain 7–13 weeks; 3: > 13 weeks.…”

Functional Outcomes of Arthroscopic Partial Meniscectomy Versus Physical Therapy for Degenerative Meniscal Tears Using a Patient-Specific Score: A Randomized Controlled Trial

“…Additional goal setting for each activity will further enhance treatment involvement, satisfaction, and perceived recovery. 23,24…”

“…Furthermore, assessing treatment effects using patient-specific activities can enhance treatment involvement, satisfaction, and perceived recovery. 23 This study compared the effectiveness of partial meniscectomy versus physical therapy on patient-specific activities over 24 months for middle-aged and older patients with degenerative meniscal tears. We used the PSFS in addition to the fixed-item IKDC form, as previously published, 26,28 to assess differences between these treatments.…”

Illness perceptions associated with patient burden with musculoskeletal pain in outpatient physical therapy practice, a cross-sectional study

“…Physical functioning was assessed with the PSFS, which is known to be a feasible and reliable instrument (Stevens et al, 2017;Beurskens et al, 1999).…”