Goal setting during rehabilitation early and late after acquired brain injury

Goal setting in one format or another is used by most acute, post-acute and community rehabilitation teams. However, the contribution that goal setting makes to the rehabilitation process is not yet established. Similarly, the specific form of goal setting that is most useful is still to be determined. The purpose of this review was to examine recent studies of goal setting and identify implications for clinical practice both early and late after brain injury.

Increasing patient involvement in the goal-setting process is feasible without significant additional resource, improves the patient experience of rehabilitation, and changes the nature of goals set to goals that are more meaningful to individuals without loss of levels of overall goal achievement. There is preliminary evidence that reminding technology can enhance learning of goals in both inpatient and outpatient rehabilitation. Goal-attainment scaling offers a means of measuring outcome in complex, multidisciplinary rehabilitation programmes. Its sensitivity to change may be increased by adoption of a six-point grading scale, but questions have been raised concerning its reliability as a tool for use in randomised controlled trials.

Goal setting is not just an administrative tool, it is a clinical intervention. Rehabilitation team members should question whether practice within their own service is optimal and in particular the extent to which their current goal setting practice genuinely involves, wherever possible, patients as collaborative partners. Provision of support to participate in goal setting as well as to remember goals and use goal progress feedback may be necessary.