Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T23:41:14.041Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  17 May 2019

Sarah Prescott ,
Emmah Doig ,
Jennifer Fleming  and
Nicole Weir
Sarah Prescott*
Affiliation:
School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia Campus, Brisbane, Queensland, Australia
Emmah Doig
Affiliation:
School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia Campus, Brisbane, Queensland, Australia
Jennifer Fleming
Affiliation:
School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia Campus, Brisbane, Queensland, Australia
Nicole Weir
Affiliation:
Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
*
*corresponding author. Email: s.prescott@uq.edu.au
Get access

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.

Keywords

Goal settingbrain injuryclient-centrednesscommunity-dwelling clients
Type
Articles
Information
Brain Impairment , Volume 20 , Issue 3 , December 2019 , pp. 226 - 239
Copyright
© Australasian Society for the Study of Brain Impairment 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barnard, R. A., Cruice, M. N., & Playford, E. D. (2010). Strategies used in the pursuit of achievability during goal setting in rehabilitation. Qualitative Health Research, 20(2), 239–250. doi: 10.1177/1049732309358327CrossRefGoogle ScholarPubMed
Barnes, M., & Ward, A. (2000). Textbook of rehabilitation medicine. Oxford: Oxford University Press.Google Scholar
Bergquist, T., & Jacket, M. (1993). Awareness and goal setting with the traumatically brain injured. Brain Injury, 7, 275–282.CrossRefGoogle ScholarPubMed
Bodiam, C. (1999). The use of the Canadian Occupational Performance Measure for the assessment of outcome in a neurorehabilitation unit. British Journal of Occupational Therapy, 62(3), 123–126. doi: 10.1177/030802269906200310CrossRefGoogle Scholar
Bouwens, S. F. M., van Heugten, C. M., & Verhey, F. R. J. (2009). The practical use of goal attainment scaling for people with acquired brain injury who receive cognitive rehabilitation. Clinical Rehabilitation, 23(4), 310–320. doi: 10.1177/0269215508101744CrossRefGoogle ScholarPubMed
Bovend’ Eerdt, T., Botell, R., & Wade, T. (2009). Writing SMART rehabilitation goals and achieving goal attainment scaling: A practical guide. Clinical Rehabilitation, 23, 352–361. doi: 10.1177/0269215508101741CrossRefGoogle Scholar
Bright, F., Boland, P., Rutherford, S., Kayes, N., & McPherson, K. (2012). Implementing a client-centred approach in rehabilitation: An autoethnography. Disability and Rehabilitation, 34(12), 997–1004. doi: 10.3109/09638288.2011.629712CrossRefGoogle ScholarPubMed
Carswell, A., McColl, M., Baptiste, S., Law, M., Polatajko, H., & Pollock, N. (2004). The Canadian Occupational Performance Measure: A research and clinical literature review. Canadian Journal of Occupational Therapy, 71(4), 210–222. doi: 10.1177/000841740407100406CrossRefGoogle ScholarPubMed
Chen, Y. H., Rodger, S., & Polatajko, H. (2002). Experiences with the COPM and client- centred practice in adult neuro-rehabilitation in Taiwan. Occupational Therapy International, 9, 167–184. doi: 10.1002/oti.163CrossRefGoogle Scholar
Cott, C. (2004). Client-centred rehabilitation: Client perspectives. Disability and Rehabilitation, 26(24), 1411–1422. doi: 10.1080/09638280400000237CrossRefGoogle ScholarPubMed
Culley, C., & Evans, J. J. (2010). SMS text messaging as a means of increasing recall of therapy goals in brain injury rehabilitation: A single-blind within-subjects trial. Neuropsychologial Rehabilitation, 20(1), 103–119. doi: 10.1080/09602010902906926CrossRefGoogle ScholarPubMed
Cup, E. H., Scholte op Reimer, W. J., Thijssen, M. C., & van Kuyk-Minis, M. A. (2003). Reliability and validity of the Canadian Occupational Performance Measure in stroke patients. Clinical Rehabilitation, 17, 402–409. doi: 10.1191/0269215503cr635oaCrossRefGoogle ScholarPubMed
D’Cruz, K., Unsworth, C., Roberts, K., Moraty, J., Turner-Stokes, L., Wellington-Boyd, A., Lannin, N. (2016). Engaging patients with moderate to severe acquired brain injury in goal setting. International Journal of Therapy and Rehabilitation, 23(1), 20–31. doi: 10.12968/ijtr.2016.23.1.20CrossRefGoogle Scholar
Doig, E., Fleming, J., Cornwell, P. L., & Kuipers, P. (2009). Qualitative exploration of a client-centered, goal-directed approach to community-based occupational therapy for adults with traumatic brain injury. American Journal of Occupational Therapy, 63(5), 559–568. doi: 10.5014/ajot.63.5.559CrossRefGoogle ScholarPubMed
Doig, E., Fleming, J., Kuipers, P., & Cornwell, P. L. (2010). Clinical utility of the combined use of the Canadian Occupational Performance Measure and Goal Attainment Scaling. American Journal of Occupational Therapy, 64(6), 904–914. doi: 10.5014/ajot.2010.08156CrossRefGoogle ScholarPubMed
Doig, E., Prescott, S., Fleming, J., Cornwell, P., & Kuipers, P. (2015). Development and construct validation of the Client-Centredness of Goal Setting (C-COGS) scale. Scandanavian Journal of Occupational Therapy, 22(4), 302–310. doi: 10.3109/11038128.2015.1017530.CrossRefGoogle ScholarPubMed
Doig, E., Prescott, S., Fleming, J., Cornwell, P., & Kuipers, P. (2016). Reliability of the Client-Centredness of Goal Setting (C-COGs) scale in acquired brain injury rehabilitation. American Journal of Occupational Therapy, 70(4), 7004290010. doi: 10.5014/ajot.2016.017046CrossRefGoogle Scholar
Hanley, J., Negassa, A., Edwardes, M., & Forrester, J. (2003). Statistical analysis of corrected data using generalised estimating equations: An orientation. Practice of Epidemiology, 157(4), 364–375. doi: 10.1093/aje/kwf215Google Scholar
Hassett, L., Simpson, G., Cotter, R., Whiting, D., Hodgkinson, A., & Martin, D. (2015). A propspective interupted time series study of interventions to improve quality, rating, framing and structure of goal-setting in community-based brain injury rehabilitation. Clinical Rehabilitation, 29(4), 327–338. doi: 10.1177/0269215514544040CrossRefGoogle Scholar
IBM Corp. (2016). IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.Google Scholar
Jenkinson, N., Ownsworth, T., & Shum, D. (2007). Utility of the Canadian Occupational Performance Measure in community-based brain injury rehabilitaion. Brain Injury, 21(12), 1283–1284. doi: 10.1080/02699050701739531CrossRefGoogle Scholar
Law, M., Baptiste, S., Carswell, A., Mccoll, M., Polatajko, H., & Pollick, N. (1998). The Canadian Occupational Performance Measure (3rd ed.). Ottowa, ON: COAT Publications.Google Scholar
Levack, W., Dean, S., Siegert, R., & McPherson, K. (2006). Purposes and mechanisms of goal planning in rehabilitation: The need for critical distinction. Disability & Rehabilitation, 28(12), 741–749.CrossRefGoogle ScholarPubMed
Levack, W. M., Dean, S. G., McPherson, K. M., & Siegert, R. J. (2006). How clinicians talk about the application of goal planning to rehabilitation for people with brain injury – variable interpretations of value and purpose. Brain Injury, 20(13-14), 1439–1449. doi: 10.1080/02699050601118422CrossRefGoogle ScholarPubMed
Levack, W. M., & Siegert, R. J. (2015). Challenges in theory, practice and evidence. In Siegert, R. &Levack, W. M. (Eds.), Rehabilitation goal setting: Theory, practice and evidence (pp. 3–19). Boca Raton: CRC Press.Google Scholar
Marsland, E., & Bowman, J. (2010). An interactive education session and follow-up support as a strategy to improve clinicians’ goal writing skills: A randomized controlled trial. Journal of Evaluation in Clinical Practice, 16, 3–13. doi: 10.1111/j.1365-2753.2008.01104.xCrossRefGoogle ScholarPubMed
McColl, M., Law, M., Baptise, S., Pollock, N., Carswell, A., & Polatajko, H. (2005). Target applications of the Canadian Occupational Performance Measure. The Canadian Journal of Occupational Therapy, 72, 298–300. doi: 10.1177/000841740507200506CrossRefGoogle Scholar
NSW Agency for Clinical Innovation. (2014). Rehabilitation goal training: participant workbook. Chatswood, NSW: Brain Injury Rehabilitation Directorate and Rehabilitation Network Agency for Clinical Innovation.Google Scholar
Ownsworth, T., Fleming, J., Shum, D., Kuipers, P., & Strong, J. (2008). Comparison of individual, group and combined intervention formats in a randomized controlled trial for facilitating goal attainment and improving psychosocial function following acquired brain injury. Journal of Rehabilitation Medicine (Stiftelsen Rehabiliteringsinformation), 40(2), 81–88. doi: 10.2340/16501977-0124CrossRefGoogle Scholar
Pagan, E., Ownsworth, T., McDonald, S., Fleming, J., Honan, C., & Togher, L. (2015). A survey of multidiciplinary clinicians working in rehabilitation for people with traumatic brain injury. Brain Impairment, 16(3), 173–195. doi: 10.1017/BrImp.2015.34CrossRefGoogle Scholar
Phipps, S., & Richardson, P. (2007). Occupational therapy outcomes for clients with traumatic brain injury and stroke using the Canadian Occupational Performance Measure. The American Journal of Occupational Therapy, 61(3), 328–334. doi: 10.5014/ajot.61.3.328CrossRefGoogle ScholarPubMed
Playford, E. D., Siegert, R. J., Levack, W. M., & Freeman, J. (2009). Areas of consensus and controversy about goal setting in rehabilitation: A conference report. Clinical Rehabilitation, 23, 334–344. doi: 10.1177/0269215509103506CrossRefGoogle ScholarPubMed
Ponsford, J., Downing, M., Olver, J., Ponsford, M., Archer, R., Carty, M., & Spitz, G. (2014). Longitudinal follow-up of patients with traumatic brain injury: Outcome at two, five and ten years post injury. Journal of Neurotrauma, 31(1), 64–77. doi: 10.1089/neu.2013.2997CrossRefGoogle ScholarPubMed
Portney, L., & Watkins, M. (2009). Foundations of Clinical Research: Applications to practice (3rd ed.). New Jersey: Pearson.Google Scholar
Prescott, S., Fleming, J., & Doig, E. (2015). Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: A systematic scoping review. Brain Injury, 29(13–14), 1515–1529. doi: 10.3109/02699052.2015.1075152CrossRefGoogle ScholarPubMed
Randall, K., & McEwen, I. (2000). Writing patient-centred functional goals. Physical Therapy, 80(12), 1197–1203.Google Scholar
Schut, H. A., & Stam, H. J. (1994). Goals in rehabilitation teamwork. Disability and Rehabilitation, 16(4), 223–226.CrossRefGoogle ScholarPubMed
Scobbie, L., Duncan, E. A., Brady, M. C., & Wyke, S. (2015). Goal setting practice in services delivering community-based stroke rehabilitation: A United Kingdom (UK) wide survey. Disability and Rehabilitation, 37(14), 1291–1298. doi: 10.3109/09638288.2014.961652CrossRefGoogle ScholarPubMed
Siegert, R., & Taylor, W. (2004). Theoretical aspects of goal-setting and motivation in rehabilitation. Disability and Rehabilitation, 26(1), 1–8. doi: 10.1080/09638280410001644932CrossRefGoogle ScholarPubMed
Sumsion, T. (2004). Pursuing the client’s goals really paid off. British Journal of Occupational Therapy, 67(1), 2–9. doi: 10.1177/030802260406700102CrossRefGoogle Scholar
Trombly, C. A., Radomski, M. V., Trexel, C., & Burnet-Smith, S. E. (2002). Occupational therapy and achievement of self-identified goals by adults with acquired brain injury. American Journal of Occupational Therapy, 56(5), 489–498. doi: 10.5014/ajot.56.5.489CrossRefGoogle ScholarPubMed
Turner-Stokes, L., Rose, H., Ashford, S., & Singer, B. (2015). Patient engagement and satisfaction with goal planning: Impact on outcome from rehabilitaion. International Journal of Therapy and Rehabilitation, 22(5), 210–216. doi: 10.12968/ijtr.2015.22.5.210CrossRefGoogle Scholar
Van De Weyer, R. C., Ballainger, C., & Playford, E. D. (2010). Goal setting in neurological rehabilitation: Staff perspectives. Diability and Rehabilitation, 32(17), 1419–1427. doi: 10.3109/09638280903574345CrossRefGoogle ScholarPubMed
Wade, D. T. (2009). Goal Setting in rehabilitation: An overview of what, why and how. Clinical Rehabilitation, 23, 291–295. doi: 10.1177/0269215509103551CrossRefGoogle Scholar
Webb, P., & Glueckauf, R. (1994). The effects of direct involvement in goal setting on rehabilitation outcome for persons with traumatic brain injuries. Rehabilitation Psychology, 39(3), 179–188.CrossRefGoogle Scholar
Ylvisaker, M., McPherson, K., Kayes, N., & Pellett, E. (2008). Metaphoric identity mapping: Facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychological Rehabilitation, 18(5–6), 713–741. doi: 10.1080/09602010802201832CrossRefGoogle ScholarPubMed