Patient centered goal-setting in a subacute rehabilitation setting

The purpose of this research is to describe current practices in goal-setting within a subacute rehabilitation setting from the perspective of therapists representing the disciplines of occupational therapy, speech pathology and physiotherapy.

Qualitative semi-structured email interviews were conducted with therapists from the Geriatric Assessment and Rehabilitation Unit of an Australian hospital. Therapists were required to respond to questioning with reference to identified rehabilitation patients with stroke.

Three approaches to goal-setting were identified: therapist controlled, therapist led and patient centred. Goals aimed at the ICF levels of impairment and activity limitations were predominant. Barriers to a patient centered goal-setting approach largely outweighed facilitators. Potential successful resolutions were offered to overcome these barriers.

The inability of patients to participate fully in the goal-setting process largely determines the approach taken by therapists. This influences the level of patient centeredness incorporated into the goal-setting process. Goals expressed at the level of impairment, by therapists, may be stepping stones to perceived patient goals at the levels of activity and participation. Barriers to a patient centered approach can be overcome through education of the patient and family regarding the nature of the injury and modification of communication between therapist and patient.