Date Presented 04/20/2023
Research is needed on goal setting for patient-identified goals and areas of occupation prioritized. Goals by five therapists were not set if 'not attainable or are unrealistic.' Goals were least likely set for instrumental activities of daily living, followed by leisure, and then basic activities of daily living. The most goals were set for social participation.
Primary Author and Speaker: Theresa M. Smith
Occupational therapists collaborate with patients on goal setting, but it involves more than soliciting patient preferences. Therapists must consider patient rehab potential, safety issues, cognitive abilities and reimbursement agencies, and their own practice domain, skill level, ethical standards, and licensure laws. There are a limited number of studies on rehab goal setting, and none located on goal setting in low vision rehab or of goal setting for different types of activities or areas of occupations. This study aimed to determine: (1) What reasons affect whether a therapist includes a patient identified goal in the patient plan of care? (2) In which areas of occupation are patient identified goals most likely to be included in a patient plan of care? A survey research design was used, and the survey included 15 most likely reasons a therapist decides not to include a patient identified (PID) goal in patient plan of care. PID goals were determined using the Activity Inventory (AI). If a patient rated an AI activity as important and moderately difficult to complete, it was considered a PID goal. Using data from a larger study, therapist patient goals were collected, and an individualized survey was constructed for each therapist. Therapist surveys included all PID activities for which they had not set a goal followed by the list of 15 reasons they did not. Five therapists completed their survey on their patients among 91 patients. Four therapists practiced in home health and a fifth in outpatient. The most common reason not to set PID goals was ‘many other goals that the patient wanted to work on’ except for IADL. The most common reason not to set IADL goals was the PID goal was ‘not attainable or are unrealistic.’ The most noted area of occupation for which PID goals were not set was IADL, followed by Leisure, and then BADL. Social participation was the area of occupation with the most PID goals set. Therapists in low vision rehab in part prioritize goal setting by limiting the number of goals set in the patient POC. Future research should include differences in goal setting in service provider agencies that are not dependent upon reimbursement agencies such as the Veterans Administration or in other countries that have public health services. Goal setting for additional diagnoses and other age groups should also be studied.
Dekker, J., de Groot, V., ter Steeg, A. M., Vloothuis, J., Holla, J., Collette, E., Satink, T., Post, L., Doodeman, S., & Littooij, E. (2020). Setting meaningful goals in rehabilitation: Rationale and practical tool. Clinical Rehabilitation, 34(1), 3–12. https://doi.org/10.1177/0269215519876299
Levack, W. M., Dean, S. G., Siegert, R. J., & McPherson, K. M. (2011). Navigating patient-centered goal setting in inpatient stroke rehabilitation: How clinicians control the process to meet perceived professional responsibilities. Patient Education and Counseling, 85(2), 206–213. https://doi.org/10.1016/j.pec.2011.01.011
Plant, S. E., Tyson, S. F., Kirk, S., & Parsons, J. (2016). What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis. Clinical Rehabilitation, 30(9), 921–930. https://doi.org/10.1177/0269215516655856
Massof, R. W., Ahmadian, L., Grover, L. L., Deremeik, J. T., Goldstein, J. E., Rainey, C., Epstein, C., & Barnett, G. D. (2007). The Activity Inventory: an adaptive visual function questionnaire. Optometry and vision science : official publication of the American Academy of Optometry, 84(8), 763–774. https://doi.org/10.1097/OPX.0b013e3181339efd