Journal Club Discussion #10: Goal Setting & Functional Outcomes

Hey readers, it’s time for another Journal Club Discussion! I can’t believe that this is the TENTH journal club discussion that I have posted. (Patting myself on the back here for sticking to my goal!) Speaking of goals, this week’s article is on goal setting’s relation to occupational performance. I talked a bit about goal setting this week on my Instagram account (check it out!), so I figured I would keep the conversation going and relate it back to occupation. The article that we are reading this week is called “Goal Setting and Functional Outcomes in Rehabilitation” by Mary Ponte-Allan and Gordon Muir Giles. AOTA members can read the article here. (This article is a little bit dated, but I felt like the message was still important!)

Background Info

At the heart of occupational therapy is client-centeredness. Clients are more willing and motivated to engage in therapy if the activity that they are doing holds meaning or interest to them. Therefore, clients should be involved in their own goal setting and treatment planning. This study examined the type of goal setting with functional outcome in patients who had a stroke. The three types of goals that were examined were as follows:

  • Goals focused on function and independence
  • General goals less focused on function
  • No stated goal

The authors defined a “function, independence-focused goal…as a statement of the desire to perform a specific activity or to return to the performance of a specific activity or a direct statement of the desire to be more independent or to return to a prior level of independence” (Ponte-Allan & Giles, 1999, p. 646). With this definition, the authors hypothesized that patients who stated goals focused on function and independence upon hospital admission would display better outcomes at discharge.

An example of a goal focused on function and independence is: I want to be able to brush my teeth at the sink by myself.

An example of a general goal not focused on function and independence is: I want to be able to use my left hand again.

The Results

The authors found that the group of patients who did not state a goal focused on function and independence had significantly longer lengths of stay in rehabilitation than the group of patients who did state a goal focused on function and independence. Secondly, the authors found that the group who stated goals focused on function and independence earned significantly higher scores on the Functional Independence Measure (FIM) than did the group who stated general goals.

In discussing the results, the authors wondered whether cognitive ability may have impacted the type of goal stated and the functional outcome determined at discharge since lower cognition tends to lead to poorer function (Ponte-Allan & Giles, 1999). However, upon admission, both groups earned equal scores on the FIM and therefore did not display differing cognitive status, leading the authors to believe that improved functional outcome in the function and independence goal group was related to the type of goal rather than cognitive status.

What I Think

I think that this is really relevant to what we have been talking about in OT school! In many of my classes, we have discussed the importance of including the client in goal setting and in planning care in order to make therapy client-centered and occupation-based. It is great to see that evidence supports the use of functionally-related goals because they may lead to improved functional outcome measures.

I think that while not all patients will willingly state a goal that is specific to function and independence, the OT practitoner can dig deeper to find out what motivates the client. If the OT can determine activities that the client wants or needs to do in his/her daily life as well as things that are meaningful to him/her and includes those as part of therapy, then odds are that the client will engage more in the OT sessions and will experience more positive outcomes.

Question of the Week: Do you include your patients/clients in goal setting and treatment planning? Do you see more functional progress among patients who express function and independence-related goals than those who do not?

Citation: Ponte-Allan, M. & Giles, G. M. (1999). Goal Setting and Functional Outcomes in Rehabilitation. The American Journal of Occupational Therapy, 53(6), 646-649).

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