A review of goal planning in the rehabilitation of the spinal cord injured person

Goal planning: a retrospective audit of rehabilitation process and outcome

Objective: To consider the effectiveness of a goal planning programme for people with spinal cord injury (SCI) and address some of the current evidence gaps in goal setting.

Design: Retrospective audit.

Subjects: Consecutive series of 65 newly injured SCI patients.

Main outcome measures: The Needs Assessment Checklist (NAC) has been specifically developed for the SCI population, and is used to assess patient attainment in core rehabilitation areas. A ‘Goal Planning Progress’ form was also used to specifically detail the goal planning process.

Results: Across the 65 patients, 396 goal planning meetings were held with 6176 goals set in total. Seventy-two per cent of the goals set at the first goal planning meeting were achieved by the second meeting. The rate of achievement at subsequent meetings was 68%. Significant differences in the number of planned rehabilitation days, number of goal planning meetings, and goals set were identified between injury categories. Significant positive correlations were found between the number of goals set and achievement, as measured by the NAC, in certain rehabilitation domains.

Conclusions: The findings of this study demonstrate that the Needs Assessment and Goal Planning framework is effective in planning SCI rehabilitation. The capacity of this goal planning system to reflect individual need has also been established. Further systematic analyses of this process could potentially lead to more efficient rehabilitation and the identification of care pathways within clinical areas.

Rebuilding self-confidence after cancer: a feasibility study of life-coaching

BACKGROUND

Cancer survivors often experience decreased self-confidence which impacts negatively on their ability to self-manage the practical, social and emotional problems frequently faced as they emerge from end of treatment. This was a feasibility study of a life-coaching intervention, designed to rebuild confidence of survivors and support transition to life after cancer treatment.

METHODS

A one group pre-test, post-test design was used, recruiting participants from community organisations. Eligibility criteria are as follows: <1 year of completion of primary cancer treatment, aged >18, no metastases, and no mental health problems. Participants received one individualised face-to-face and five telephone coaching sessions over 3 months. Outcome measures are as follows: New General Self-Efficacy Scale, Hope Scale, Personal Well-being Index, Assessment of Survivorship Concerns, Quality of Life in Adult Cancer Survivors, Hospital Anxiety and Depression Scale, Social Difficulties Index, and a goal attainment score. Interviews explored feasibility, acceptability and impact of life-coaching and research design.

RESULTS

Nine women and two men were recruited, representing varying cancer diagnoses. All outcome measures were sensitive to change and indicated positive trends post-intervention. Participant interviews indicated the intervention was well received and had a positive impact. Lessons were learnt about study design, recruitment and intervention delivery.

CONCLUSIONS

Life-coaching has a potential to enable cancer survivors to manage the transition to life beyond cancer and effect change on a range of outcomes. The intervention was feasible to deliver and acceptable to survivors at a time when many struggle to make sense of life. It merits further evaluation through a randomised controlled trial.

The role of patient education in the rehabilitation of people with spinal cord injuries

Individuals with newly acquired spinal cord injuries need to be educated to manage the consequences of their neurological impairment and disability. However, to enable individuals with long-term conditions to manage their own care, they need to be provided with more than simply information about their condition. Critical to independence and self-management are empowerment and self-efficacy. As part of the process of rehabilitation, patient education programmes need to incorporate teaching strategies that develop these key skills to facilitate a successful outcome of rehabilitation for the patient.

This article will explore these strategies, and the theories behind them, from a nursing perspective; highlighting how the rehabilitation professional can use these to improve patient outcomes.

Goal setting as an outcome measure: a systematic review

Background: Goal achievement has been considered to be an important measure of outcome by clinicians working with patients in physical and neurological rehabilitation settings. This systematic review was undertaken to examine the reliability, validity and sensitivity of goal setting and goal attainment scaling approaches when used with working age and older people.

Aims and objectives: To review the reliability, validity and sensitivity of both goal setting and goal attainment scaling when employed as an outcome measure within a physical and neurological working age and older person rehabilitation environment, by examining the research literature covering the 36 years since goal-setting theory was proposed.

Methods: Data sources included a computer-aided literature search of published studies examining the reliability, validity and sensitivity of goal setting/goal attainment scaling, with further references sourced from articles obtained through this process.

Main findings: There is strong evidence for the reliability, validity and sensitivity of goal attainment scaling. Empirical support was found for the validity of goal setting but research demonstrating its reliability and sensitivity is limited.

Conclusions: Goal attainment scaling appears to be a sound measure for use in physical rehabilitation settings with working age and older people. Further work needs to be carried out with goal setting to establish its reliability and sensitivity as a measurement tool.

Patient-professional partnership in spinal cord injury rehabilitation

There has been considerable pressure from both patients and professionals for greater patient involvement in the delivery of health services in recent years, particularly in the domain of rehabilitation. However, it has been suggested that involvement by patients is limited to rehabilitation. Accordingly, this study aimed to explore and describe patients' and professionals' experiences of patient participation in team decision-making processes. This article presents findings from a larger ethnographic study, which employed interviews and participant observation to collect data. This article focuses on the results from semistructured interviews, which were conducted with 30 healthcare professionals and 20 patients in a spinal cord injury unit in the UK. Findings suggest that the experience of team membership and decision-making is shaped by professional paternalism. Patients and professionals perceive that they are involved in a partnership where patients make decisions. However, different levels of paternalism in the professional-patient relationship within team decision-making processes emerged from the data. These have been categorized as 'open paternalism' where power and control lies with professionals; 'they tell me what they are doing' where patients are informed of decisions; 'they can always say no' where patients can agree or disagree; 'making the right choice' where patients are steered towards the choice professionals consider as the 'right' choice; and 'active participation' where patients choose the course of action. It is suggested that professionals should examine their own practice and attempt to develop ways of working that empower patients to become equal members of the rehabilitation team.