Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating

202 Pages·2015·2.08 MB·English

Goal setting and strategies to enhance goal pursuit for adults
with acquired disability participating in rehabilitation (Review)
Levack WMM, Weatherall M, Hay-SmithEJC, Dean SG, McPherson K, SiegertRJ
ThisisareprintofaCochranereview,preparedandmaintainedbyTheCochraneCollaborationandpublishedinTheCochraneLibrary
2015,Issue7
http://www.thecochranelibrary.com
Goalsettingandstrategiestoenhancegoalpursuitforadultswithacquireddisabilityparticipatinginrehabilitation(Review)
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAINLANGUAGESUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
SUMMARYOFFINDINGSFORTHEMAINCOMPARISON . . . . . . . . . . . . . . . . . . . 4
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Figure1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Figure2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Figure3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Figure4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Figure5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Figure6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
ADDITIONALSUMMARYOFFINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 34
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
AUTHORS’CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
CHARACTERISTICSOFSTUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
DATAANDANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Analysis1.1.Comparison1Goalsetting(withorwithoutstrategiestoenhancegoalpursuit)versusnogoalsetting,
Outcome1Healthrelatedqualityoflifeorself-reportedemotionalstatus. . . . . . . . . . . . . . 167
Analysis1.2.Comparison1Goalsetting(withorwithoutstrategiestoenhancegoalpursuit)versusnogoalsetting,
Outcome2Activity-ability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Analysis1.3.Comparison1Goalsetting(withorwithoutstrategiestoenhancegoalpursuit)versusnogoalsetting,
Outcome3Engagementinrehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . 169
Analysis1.4.Comparison1Goalsetting(withorwithoutstrategiestoenhancegoalpursuit)versusnogoalsetting,
Outcome4Self-efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Analysis2.1.Comparison2Structuredgoalsetting(withorwithoutstrategiestoenhancegoalpursuit)versusnostructured
goalsetting,Outcome1Healthrelatedqualityoflifeorself-reportedemotionalstatus. . . . . . . . . 171
Analysis2.2.Comparison2Structuredgoalsetting(withorwithoutstrategiestoenhancegoalpursuit)versusnostructured
goalsetting,Outcome2Activity-ability. . . . . . . . . . . . . . . . . . . . . . . . . 172
Analysis2.3.Comparison2Structuredgoalsetting(withorwithoutstrategiestoenhancegoalpursuit)versusnostructured
goalsetting,Outcome3Self-efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Analysis2.4.Comparison2Structuredgoalsetting(withorwithoutstrategiestoenhancegoalpursuit)versusnostructured
goalsetting,Outcome4Satisfactionwithservicedelivery. . . . . . . . . . . . . . . . . . . 174
Analysis2.5.Comparison2Structuredgoalsetting(withorwithoutstrategiestoenhancegoalpursuit)versusnostructured
goalsetting,Outcome5Adverseevents(withdrawalduetodeath,re-hospitalisationorworseningsymptoms). 175
ADDITIONALTABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
CONTRIBUTIONSOFAUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
DECLARATIONSOFINTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
SOURCESOFSUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
DIFFERENCESBETWEENPROTOCOLANDREVIEW . . . . . . . . . . . . . . . . . . . . . 199
Goalsettingandstrategiestoenhancegoalpursuitforadultswithacquireddisabilityparticipatinginrehabilitation(Review) i
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
[InterventionReview]
Goal setting and strategies to enhance goal pursuit for adults
with acquired disability participating in rehabilitation
WilliamMMLevack1,MarkWeatherall1,E.JeanCHay-Smith1,SarahGDean2,KathrynMcPherson3,RichardJSiegert3,4
1RehabilitationTeachingandResearchUnit,DepartmentofMedicine,UniversityofOtago,Wellington,NewZealand.2University
ofExeterMedicalSchool,UniversityofExeter,Exeter,UK.3SchoolofRehabilitationandOccupationStudies,AucklandUniversity
of Technology, Auckland, New Zealand. 4School of Public Health and Psychosocial Studies, Auckland University of Technology,
Auckland,NewZealand
Contactaddress:WilliamMMLevack,Rehabilitation TeachingandResearchUnit,DepartmentofMedicine,UniversityofOtago,
MeinSt,Newtown,POBox7343,Wellington,6242,[email protected].
Editorialgroup:CochraneConsumersandCommunicationGroup.
Publicationstatusanddate:New,publishedinIssue7,2015.
Reviewcontentassessedasup-to-date: 25March2014.
Citation: LevackWMM,WeatherallM,Hay-SmithEJC,DeanSG,McPhersonK,SiegertRJ.Goalsettingandstrategiestoenhance
goalpursuitforadultswithacquireddisabilityparticipatinginrehabilitation.CochraneDatabaseofSystematicReviews2015,Issue7.
Art.No.:CD009727.DOI:10.1002/14651858.CD009727.pub2.
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
ABSTRACT
Background
Goalsettingisconsideredakeycomponentofrehabilitationforadultswithacquireddisability,yetthereislittleconsensusregarding
thebeststrategiesforundertakinggoalsettingandinwhichclinicalcontexts.Ithasalsobeenunclearwhateffect,ifany,goalsetting
hasonhealthoutcomesafterrehabilitation.
Objectives
To assess the effects of goal setting and strategies to enhance the pursuit of goals (i.e. how goals and progress towards goals are
communicated,used,orshared)onimprovinghealthoutcomesinadultswithacquireddisabilityparticipatinginrehabilitation.
Searchmethods
We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trials registers to December 2013, together with
referencechecking,citationsearchingandcontactwithstudyauthorstoidentifyadditionalstudies.Wedidnotimposeanylanguage
ordaterestrictions.
Selectioncriteria
Randomisedcontrolledtrials(RCTs),cluster-RCTsandquasi-RCTsevaluatingtheeffectsofgoalsettingorstrategiestoenhancegoal
pursuitinthecontextofadultrehabilitationforacquireddisability.
Datacollectionandanalysis
Two authors independently reviewedsearchresultsfor inclusion. Grey literature searcheswereconducted and reviewedbyasingle
author. Two authors independently extracted data and assessed risk of bias for included studies. We contacted study authors for
additionalinformation.
Goalsettingandstrategiestoenhancegoalpursuitforadultswithacquireddisabilityparticipatinginrehabilitation(Review) 1
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Mainresults
We included39 studies (27 RCTs, 6cluster-RCTs, and6 quasi-RCTs) involving 2846 participants in total. Studiesranged widely
regardingclinicalcontextandparticipants’primaryhealthconditions.Themostcommonhealthconditionsincludedmusculoskeletal
disorders,braininjury,chronicpain,mentalhealthconditions,andcardiovasculardisease.
Eighteenstudiescomparedgoalsetting,withorwithoutstrategiestoenhancegoalpursuit,tonogoalsetting.Thesestudiesprovide
verylowqualityevidencethatincludinganytypeofgoalsettinginthepracticeofadultrehabilitationisbetterthannogoalsettingfor
health-relatedqualityoflifeorself-reportedemotionalstatus(8studies;446participants;standardisedmeandifference(SMD)0.53,
95%confidenceinterval(CI)0.17to0.88, indicativeofamoderateeffectsize)andself-efficacy(3studies;108participants;SMD
1.07,95%CI0.64to1.49,indicativeofamoderatetolargeeffectsize).Theevidenceisinconclusiveregardingwhethergoalsetting
resultsinimprovementsinsocial participation or activity levels,body structureor function, or levelsofpatientengagement inthe
rehabilitationprocess.Insufficientdataareavailabletodeterminewhetherornotgoalsettingisassociatedwithmoreorfeweradverse
eventscomparedtonogoalsetting.
Fourteenstudiescomparedstructuredgoalsettingapproaches,withorwithoutstrategiestoenhancegoalpursuit,to’usualcare’that
mayhaveinvolvedsomegoalsettingbutwherenostructuredapproachwasfollowed.Thesestudiesprovideverylowqualityevidence
thatmorestructuredgoalsettingresultsinhigherpatientself-efficacy(2studies;134participants;SMD0.37,95%CI0.02to0.71,
indicativeofasmalleffectsize)andlowqualityevidenceforgreatersatisfactionwithservicedelivery(5studies;309participants;SMD
0.33,95%CI0.10to0.56,indicativeofasmalleffectsize).Theevidencewasinconclusiveregardingwhethermorestructuredgoal
settingapproachesresultinhigherhealth-relatedqualityoflifeorself-reportedemotionalstatus,socialparticipation, activitylevels,
orimprovementsinbodystructureorfunction.Threestudiesinthisgroupreportedonadverseevents(death,re-hospitalisation,or
worseningsymptoms),butinsufficientdataareavailabletodeterminewhetherstructuredgoalsettingisassociatedwithmoreorfewer
adverseeventsthanusualcare.
Amoderatedegreeofheterogeneitywasobservedinoutcomesacrossallstudies,butaninsufficientnumberofstudieswasavailableto
permitsubgroupanalysistoexplorethereasonsforthisheterogeneity.Thereviewalsoconsidersstudieswhichinvestigatetheeffects
ofdifferentapproachestoenhancinggoalpursuit,andstudieswhichinvestigatedifferentstructuredgoalsettingapproaches.Italso
reportsonsecondaryoutcomesincludinggoalattainmentandhealthcareutilisation.
Authors’conclusions
Thereissomeverylowqualityevidencethatgoalsettingmayimprovesomeoutcomesforadultsreceivingrehabilitationforacquired
disability. The best of this evidence appears to favour positive effectsfor psychosocial outcomes (i.e. health-relatedquality of life,
emotionalstatus,andself-efficacy)ratherthanphysicalones.Duetostudylimitations,thereisconsiderableuncertaintyregardingthese
effectshowever,andfurtherresearchishighlylikelytochangereportedestimatesofeffect.
PLAIN LANGUAGE SUMMARY
Goalsettingforadultsreceivingclinicalrehabilitationfordisability
Background
Goalsettingisconsideredakeypartofclinicalrehabilitationforadultswithdisability,suchasinrehabilitationfollowingbraininjuries,
heartorlungdiseases,mentalhealthillnesses,orforinjuriesorillnessesinvolvingbonesandmuscles.Healthprofessionalsusegoalsto
providetargetsforthemselvesandtheirclientstoworktowards.Inthisreviewwesummarisestudiesthathaveinvestigatedwhateffect,
ifany,goalsettingactivitieshaveonachievinggoodhealthoutcomesfollowingrehabilitation.
Results
Thisreviewfound39studiespublishedbeforeDecember2013,involvingatotalof2846participantsreceivingrehabilitationinavariety
ofcountriesandclinicalsituations.Thestudiesusedawiderangeofdifferentapproachestogoalsettingandtestedtheeffectivenessof
theseapproachesinanumberofdifferentways. Overallthesestudiesprovideverylowqualityevidencethatgoalsettinghelpspatients
achieveahigherqualityoflifeorsenseofwell-beingandahigherbeliefintheirownabilitytoachievegoalsthattheychoosetopursue.
Thereiscurrentlynoconsistentevidencethatgoalsettingimprovespeople’sfunctionalabilitiesafterrehabilitationorhowhardthey
trywiththerapeuticinterventionsduringrehabilitation.
Goalsettingandstrategiestoenhancegoalpursuitforadultswithacquireddisabilityparticipatinginrehabilitation(Review) 2
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Insufficientinformationexiststosaywhethergoalsettingincreasesorreducestheriskofadverseevents(suchasdeathorre-hospitali-
sation)forpeopleinvolvedinrehabilitation.Becauseofthevarietyofapproachestostudyinggoalsettinginrehabilitationandbecause
oflimitationsinthedesignofmanystudiescompletedtodate,itisverypossiblethatfuturestudiescouldchangetheconclusionsof
thisreview. Wealsoneedmoreresearchtoimproveourunderstandingofhowcomponentsofthegoalsettingprocess(suchashow
difficultgoalsare,howgoalsoftherapyshouldbeselectedandprioritised,howgoalsareusedinclinicalpractice,andhowfeedbackon
progresstowardsgoalsshouldbeprovided)contributeordonotcontributetobetterhealthoutcomes.
Goalsettingandstrategiestoenhancegoalpursuitforadultswithacquireddisabilityparticipatinginrehabilitation(Review) 3
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
CoGo SUMMARY OF FINDINGS FOR THE MAIN COMPARISON [Explanation]
pa
yl
right©setting
2a
0n Goalsettingwithorwithoutstrategiestoenhancegoalpursuitcomparedtonogoalsettingforadultswithacquireddisabilityparticipatinginrehabilitation
1d
5s
Thtra
ete Patientorpopulation:adultswithacquireddisabilityparticipatinginrehabilitation
Cg
oie Settings:inpatient,outpatient,andcommunity-basedhealthcareservices
chrasto Intervention:goalsettingwithorwithoutstrategiestoenhancegoalpursuit
ne
eCnha Comparison:nogoalsetting
on
llace
boration.Pgoalpursu Outcomes Illustrativecomparativerisks*(95%CI) N(sotuodfiePsa)rticipants Q(GuRaAlitDyEo)ftheevidence Comments
ublisheditforadu ANsosguomaeldsertistikng CGoorarlesseptotinndgin(gwritihskorwithout
bylts strategiesto enhance goal
Jow
hnith pursuit)
Wa
c
ileyquir Health-related quality of life The mean Physical Compo- The mean Physical Compo- 446 ⊕(cid:13)(cid:13)(cid:13) Higher scores indicate better
&ed or self-reported emotional nentSummaryScoresonthe nentSummaryScoresonthe (8studies) verylow3,4,5 outcomes. Scores estimated
Sondis status ShortForm-36forthecontrol Short Form-36 for the inter- usingaSMDof0.54(95%CI
s,ab
Ltd.ilityp wFoelelokws-up: median 11.5 g3r5o.u9ppwoiansts(SD10.1)(outof v5e.5nthioinghgerroupwas 0ef.f1e7cttosiz0e.8th8a)t,minadyicraatnivgeeofrfoamn
a
rtic apossiblescoreof0-100)1 (1.7to8.9higher)2 small to large.Two additional
ip studies with 142 participants
a
tin however, reported no means
g
in or SD, but indicated that goal
r
eh setting may lead to little to
a
b nodifference inhealth-related
ilita quality of life or self-reported
tion emotionalstatus
(R
e
v
ie Participation Seecomment Seecomment 254 ⊕(cid:13)(cid:13)(cid:13) Outcomesunabletobepooled
w
) Follow-up:median3months (4studies) verylow3,4,6 due to lack of reporting of
dataandlackofsimilaritiesin
the types of measures used.
Weareuncertainwhethergoal
settingimprovesparticipation-
4
CG
oo
pa
yl
right©setting leveloutcomes
2a
01nd Activity ThemeanBarthelIndexscore ThemeanBarthelIndexscore 223 ⊕⊕(cid:13)(cid:13) Higher scores indicate better
5Thstra Follow-up:median18weeks forthecontrolgroupwas for the intervention groups (4studies) low3,6 outcomes. Scores estimated
ete 18 points (SD 3.3) (out of a was usingaSMDof0.04(95%CI
Cg
ochraiesto possiblescoreof0-20)7 0(0.1.7hliogwheerrto1higher)2 -s0u.g2g2estots0th.3a1t)g.oTahlsisetetivnigdemncaye
ne
eCnha notimproveactivity-level out-
ollance comes
boration.Pgoalpursu Bfuondcytionstructure and body Seecomment Seecomment 2(535studies) ⊕ve(cid:13)ry(cid:13)lo(cid:13)w8,9 Utonalabclektoofposoimliolaurtictioemseisndthuee
ublisheditforadu Follow-up:median3months tatyirnpegeusinmcopefrrotmavienesawsouhuretecthsoemrusgeesodaa.ltsWtehtee-
bylts level of body structure and
Jow
hnith bodyfunction
Wa
c
ileyquir Engagementinrehabilitation The mean number of hours The intervention groups 369 ⊕(cid:13)(cid:13)(cid:13) Higher scores indicate bet-
&ed (motivation,involvementand workedona26-weeksupport worked (9studies) verylow4,6,8,11 ter engagement. Scores es-
Sondis adherence) work placement programme 50hoursmore timated using a SMD of 0.
s,ab
Ltd.ilityp Follow-up:median8.5weeks f2o5r5thheocuornstrooflwgroorukp(sSwDa1s66) m(1o2reh)o2uornlaes2s6-twoe1e1k0suhpopuorrst 3.0On(9e5%addCitIion-0a.l07stutody0w.6i6th)
a
rtic 10 workplacementprogramme 27 participants reported no
ip means or SD but indicated
a
tin that goal setting may lead to
g
in little to no difference in en-
r
eh gagementinrehabilitation.One
a
b further study with 367 par-
ilita ticipantsmeasuredmedication
tion regime adherence as a di-
(R chotomous variable, and re-
e
v
ie ported that the odds for the
w
) goal setting group adhering
was1.13timeshigher(95%CI
1.08to 1.19) than that ofthe
5
CG
oo
pa
yl
right©setting nwoegaorealusnectetirntgaingrwouhpe.thOevregroalal,l
2a
01nd setting improves engagement
5s
Thtra inrehabilitation
ete
Cg
ochraiesto SFoelllfo-wef-fuicpa:cmyedian5weeks TschoeremfeoarnthTeasckonSterolf-legffriocuacpys Tinhteervmeenatinonseglrfo-eufpfiscawcaysin the 1(308studies) ⊕ve(cid:13)ry(cid:13)lo(cid:13)w6,8 Hteirghseerlf-esfcfiocraecsy.inSdcicoaretes ebsetti--
ne
eCnha was 0.6higher mated using a SMD of 1.07
ollance 3.3points(SD0.6)(outofa (0.4to0.9higher)2 (95%CI0.64to1.49),indica-
boration.Pgoalpursu possiblescoreof1-4)12 tfwievictehtos8fiz8ae.mpOaonrdteiecaripadatdenitttisoonlraaelrpgsoetrutedefdy-
ublisheditforadu ngreoehsatmebdielitatanhtsiaotnogmroaaSlyDsl,eeattbdinugttosaliuftttgele-r
bylts tonodifferenceinself-efficacy
Jow
hnith
Wac *Thebasisfor theassumedrisk(e.g.themediancontrol groupriskacross studies) isprovidedinfootnotes. Thecorresponding risk(andits95%confidence interval) isbasedonthe
ileyquir assumedriskinthecomparisongroupandtherelativeeffectoftheintervention(andits95%CI).
&e
Sonddis CI:Confidenceinterval;SD:standarddeviation;SMD:standardmeandifference
s,ab
Ltd.ilityp GHRigAhDqEuaWliotyrk:inFugrGthreorurpesgeraadrcehsiosfveevriydeunncliekelytochangeourconfidenceintheestimateofeffect.
a
rtic Moderatequality:Furtherresearchislikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandmaychangetheestimate.
ip Lowquality:Furtherresearchisverylikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandislikelytochangetheestimate.
a
tin Verylowquality:Weareveryuncertainabouttheestimate.
g
in
re 1ThePhysicalComponentSummaryScoreontheShortForm-36wasusedforthisillustrativecomparativeriskasthiswasdeemedto
h
ab bethemostcommon,mostgeneralmeasureofqualityoflifeusedinthestudiesincludedinthemeta-analysisforthisoutcome.The
ilita dataonassumedriskforthePhysicalComponentSummaryScoreontheShortForm-36wastakenfromcontrolgroupdatainthe
tio studythatusedthismeasure(Harwood2012).
n
(R 2Thedifferenceinthecorrespondingrisk(andits95%CI)wascalculatedbymultiplyingtheSDfortheassumedriskbytheSMDfrom
e
vie themeta-analysis(andits95%CI).
w
) 3TheGRADEratingwasdowngradedbyonelevel,givenoverallunclearriskofbias.
4TheGRADEratingwasdowngradedduetothepresenceofsubstantialunexplainedheterogeneityinthedata.
5TheGRADEratingwasdowngradedduetoimprecision,withtheconfidenceintervalfortheSMDrangingfrombelow0.2toabove0.8.
6TheGRADEratingwasdowngradedduetothesmalltotalnumberofparticipantsintheincludedstudies
6
CoGo 7 TheBarthelIndexwasusedforthisillustrativecomparativeriskasthiswasdeemedtobethemostcommon,mostgeneralmeasure
pa
yright©lsetting f8orfoTamhcetciGvoiRntytAruoDslEegdrraoituninptghdewatsaatsuinddiotehwsenisngtcrualdudydeedtdhbaiytnuttwsheeodmlethevitesals-ma,ngeaaivlsyeusnriseov(foHerraatrhlwlishoiogodhut2rci0so1km2oe)f..bTihaesdataonassumedriskfortheBarthelIndexwastaken
2a
01nd 9TheGRADEratingwasdowngradedduetothefindingsbeingbasedondescriptiveanalysisofaseriesofsmallstudiesthatcouldnot
5s
Thtra bepooledinameta-analysis,reachingdifferentconclusionsregardingtreatmenteffect,
eCteg 10 Hours worked on a support work placement was used for this illustrative comparative risk as this was deemed to be the most
ochraiesto masesaunminegdfurli,skmfoosrtthgeenheoruarlsmweoarskuedreoonfaesnugpapgoermtewnotrkuspeladcienmtehnetswtuadsietaskeinncflruodmedcoinnttrhoelgmroeutap-adnaatalyisnisthfeorsttuhdisyothuattcoumseed.tThhisemdeaatasuorne
ne
en
Cha (Bell2003).
ollance 11 TheGRADEratingwasdowngradedduetothe95%confidenceintervalcrossingthelineofnoeffectaswellasreachingabovean
boration.Pgoalpursu S1u2sMeTDdasoinkfS0th.e5elf-setfufdiciaecsyinwcalusduesdeidnftohrethmisetilalu-asntraaltyivseiscfoomrpthairsatoivuetcroismkea.sTthheisdwaatasodneeamsseudmtoedberitshkefmoroTsatsgkenSeerlaf-lemffeicaascuyrewoafssetalfk-eenfficfraocmy
ublisheditforadu controlgroupdatainthestudythatusedthismeasure(O’Brien2013).
bylts
Jow
hnith
Wa
c
ilequ
yir
&e
d
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s,ab
Ltd.ilityp
a
r
tic
ip
a
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g
in
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e
h
a
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n
(R
e
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ie
w
)
7
BACKGROUND togoal settinghasbeendescribedintheliterature,withvarious
similaritiesanddifferencesintherecommendedprocessandcon-
Goalsettingisconsideredanessentialpartofclinicalrehabilita-
tentofeach.Theseinclude(butarenotlimitedto):
tion.Ithasbeendescribedasacorepracticewithinrehabilitation
• GoalAttainmentScaling(GAS)(Kiresuk1968;
(Wade2009),arequirementforeffectiveinterdisciplinaryteam-
Turner-Stokes2009);
work(Schut1994),andanactivitythatspecificallycharacterises
• goalsettingbasedontheCanadianOccupational
bothrehabilitationservicesandthosewhoprovidethem(Barnes
PerformanceMeasure(COPM)(Pendleton2005;Phipps2007;
2000;Scobbie2009;Wade1998). Inclinicalpracticetherehas
Trombly2002;Wressle2002;Wressle2003);
beengrowingemphasisontheneedforinterventionswithpatients
• ’SMART’goalplanning(Barnes2000;Bovend’Eerdt2009;
tobegoaloriented.Goalterminologyisbecomingintegraltodis-
Mastos2007;McLellan1997;Monaghan2005;Schut1994);
cussions of guidelines, policiesand professional requirements at
• ’RUMBA’goalplanning(Barnett1999);
bothregionalandinternationallevels(e.g.Duncan2005;Evans
• Self-IdentifiedGoalAssessment(Melville2002);
2001;Randall2000;RCP2003;RCP2004;Rothstein2003).
• GoalManagementTraining(Levine2000);
Someauthorshavesuggestedthatevidencefortheeffectivenessof • approachestogoalplanningfromtheWolfson
goalsettinginimprovingpatientoutcomeshasalreadybeenfirmly NeurorehabilitationCentre(McMillan1999)
established,andthatthisevidencecannowdirecthowgoalsetting • contractually-organisedgoalsetting(Powell2002);
inrehabilitationshouldbeimplemented(Black2010;Marsland • CollaborativeGoalTechnology(Clarke2006);
2010;Wilson2008). However,asystematicreviewofrandomised • goalsettingaspartoftheProgressiveGoalAttainment
controlledtrials(RCTs)concludedthattheevidenceregardingany Programme(Sullivan2006);
generalisableeffectofgoalsettingonpatientoutcomesfollowing • patient-centredfunctionalgoalplanning(Randall2000);
rehabilitationwasinconsistentatbest,andgreatlylimitedbythe and
quality of studies published at the time (Levack 2006a). Given • goalsettingbasedonthePatientGoalPriority
thatthisreviewisnowovernineyearsold,thereisaneedtoupdate QuestionnaireorPatientGoalPriorityList(Asenlöf2009).
thiswork.
Note: ’SMART’ and ’RUMBA’ are not abbreviations, but
mnemonic acronyms for key components of goal setting, pro-
moted by various authors. Interpretations of these acronyms
Descriptionofthecondition differ (McPherson 2014; Wade 2009). One interpretation of
the’SMART’acronymisthatitstandsforSpecific,Measurable,
Thisreviewfocusesontheapplicationofgoalsettinginthecon-
Achievable,Relevant,andTime-limitedgoals(Barnes2000).Sim-
textofrehabilitationforadultswithacquireddisability.Theterm
ilarly, it is suggested that ’RUMBA’ refers to Relevant, Under-
’disability’ is defined according to the World Health Organiza-
standable,Measurable,Behavioural,andAchievablegoals(Barnett
tion’s (WHO) International Classification of Functioning, Dis-
1999).
abilityandHealth(ICF)asan’umbrellatermforimpairments,ac-
Whilethesedifferentapproachestogoalsettingfrequentlyinclude
tivitylimitationsorparticipationrestrictions’(WHO2001a,p.3)
commonfeatures,suchashavingmeasurablegoals,orpatientin-
thatresultfrominteractionsbetweenaperson(withahealthcon-
volvementingoalselection,fewsuchfeaturesareuniversaltoall
dition)andthatperson’scontextualfactors(environmentalfactors
recommendedapproaches.Indeed,allapproachestogoalsetting
and personal factors). For the purposes of this review, the term
inrehabilitationdifferfromoneanotheracrossanumberofvari-
’acquireddisability’isusedtorefermorespecificallytodisability
ables,including:
thatarisesduring aperson’sadultlife(i.e.after16yearsof age)
• thegroupintendedtousetheapproach(i.e.forusebya
followinganaccident,illnessordevelopmentofahealthcondi-
single,specificprofessionorforusebyaninterprofessionalteam);
tion.Thistermthereforeexcludesdisabilityassociatedwithhealth
• theintendedpatientpopulationfortheapproach;
conditionsarisingprenatallyorinchildhood.
• theprocessbywhichgoalsareselected(e.g.whoisinvolved;
howgoalsareidentifiedandprioritised);
• therecommendedcharacteristicsoftheactualgoalsset(i.e.
Descriptionoftheintervention
howgoalsarewritten;whethertheyneedtobephrasedina
Reviewsofliteratureongoalsettinginrehabilitationarecompli- certainway);
catedbyanumberoffactors,oneofwhichisthedifficultythat • therecommendedcontentofgoalsset(i.e.whatis
exists in describing what might (or might not) constitute ’goal consideredanacceptabletopicforagoal;whethergoalsneedto
setting’ inarehabilitation context. Theterms’goals’, ’goal set- besetataparticularleveloftheICF);
ting’and’goalplanning’havebeenusedtorefertomanydifferent • thewaythegoalsaresubsequentlyusedinclinical
constructswithlittlecurrentconsensusaroundkeyterminology environments(e.g.thewaygoalsareusedinteammeetingsor
(Levack2006b;Playford2009).Arangeofdifferentapproaches meetingswithpatients;howfeedbackonprogresstowardsgoals
Goalsettingandstrategiestoenhancegoalpursuitforadultswithacquireddisabilityparticipatinginrehabilitation(Review) 8
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