Background Person-centred goal setting and shared decision-making are emphasised as essential parts of effective team work and good clinical practice in rehabilitation.
Objectives To explore the practice of collaborative goal setting in rehabilitation for adults with rheumatic and musculoskeletal diseases (RMDs), as described in published randomized controlled trials (RCTs).
Methods A comprehensive, systematic literature search was undertaken to identify RCTs evaluating the effect of rehabilitation involving health professionals from at least two disciplines. We included trials from the period 1997–2012. Participants in the trials had a RMD with duration of more than three months.
Following a deductive approach, four categories and nine keywords were developed from existing theory (1) and prior research about goal setting. The categories were i) goal negotiation, ii) specific goal setting, iii) goal-directed planning, iv) goal evaluation. Keywords were goal, aim, expect, need, tailor, objective, target, plan and outcome. The categories and keywords were used to identify text units in the articles, which were analyzed using a directive and summative content analysis.
Results 21 RCTs were included, of which 12 included participants with chronic low back pain and 9 included participants with inflammatory arthropathies, connective tissue diseases or fibromyalgia. The intervention was inpatient or outpatient rehabilitation, and involved group and/or individual sessions. The multidisciplinary teams consisted of 3 to 7 professions. A total of 430 text units were identified, of which 18 (4%) contained descriptions of patients as active participants in the goal setting process. These units came from 8 papers. Goal negotiation was described in 7 of these 8 papers, and specific goal setting in all 8 papers. Goal-directed planning was described in 6 papers, and patient-centred goal evaluation in 3 papers. No papers described a specific instrument or a formal method of goal setting. The remaining text units (96%) did not describe any collaboration in the goal setting process between patients and health professionals. However, content related to predefined treatment goals was identified in 19 papers. These treatment goals were set by health professionals without patient involvement.
Conclusions In articles reporting results from RCTs examining the effect of rehabilitation, the occurrence of patients as active participants in collaborative goal setting in general was low, and lower than the occurrence of predefined treatment goals set by health professionals alone. The results indicate that there is a gap between the emphasis on goal setting in rehabilitation theory and its implementation in clinical practice and research.
Scobbie, Dixon, Wyke. Goal setting and action planning in the rehabilitation setting: development of a theoretically informed practice framework. Clin Rehabil 2011; 25: 468–82
Disclosure of Interest None declared