Goal-setting in physiotherapy: exploring a person-centered perspective

Figures & data

Table 1. Summary of included papers.

Authors, year	Design	Aim	Sample and setting	Intervention	Data collection	Motivation for inclusion
Cameron,	Ethnographic approach. Multiple qualitative methods.	To explore the ways clinicians engage rehabilitation patients in patient-centered goal setting and identify factors influencing the goal-setting process	17 rehabilitation patients, 18 allied health clinicians (of them, 7 physiotherapists) and one family member. Sub-acute rehabilitation	N.A.	Multiple qualitative methods: audio recorded goal-setting interviews, associated entries in the patient medical record. Focus groups with clinicians were conducted to validate themes identified	Results section describes experiences and observations of person-centered goal setting in a rehabilitation context.
de Vries et al., 2015	Pilot, development of intervention, pre-post evaluation	To develop a physical therapy strategy, Coach2Move.	12 patients with mobility problems, 2 physiotherapists Out-patient rehabilitation	Coach2Move: three different profiles in the intervention group	Interviews with patients and group discussions with physiotherapists and research group. Pre-post evaluation: physical functioning and self-reported health status	Results section describes shared decision making on meaningful treatment goals in the Coach2Move approach.
de Vries et al., 2016	Randomized controlled trial	To test the Coach2Move strategy on (cost-) effectiveness.	Elderly patients with mobility problems: 64 patients intervention group and 66 patients control group Out-patient rehabilitation	Coach2Move: three different profiles in the intervention group	Evaluations baseline, 3 months and 6 months: physical functioning and self-reported health status, number of falls during 3 months, health care utilization	Results section evaluates the Coach2Move approach including shared decision making on meaningful treatment goals
Deutsch, Maidan, and Dickstein, 2012	Case study	To describe the implementation of an integrated motor imagery intervention and the delivery of therapy both on site and through telerehabilitation	1 patient with stroke. On site and telerehabiltiation	Integrated motor imagery	N.A.	Discusses a treatment that consists of patient-centered goal setting.
Gardner et al., 2015	Pre-post intervention longitudinal cohort study	To explore goals important to patients with chronic low back pain and to investigate the extent of their alignment with outcome measures.	20 patients with chronic low back pain Out-patient rehabilitation	“Participant Workbook”, goal setting according to the SMART model, five sessions and two monthly follow up sessions	Thematically coded goals, IMPACCT outcome domains.	Results evaluates patient-led goal setting by exploring goals that are important to patients.
Hale and Piggot, 2005	Grounded theory approach. Semi-structured interviews	To address the paucity of information on the content of physiotherapeutic home-based stroke rehabilitation	20 physiotherapists Home-based stroke rehabilitation	N.A.	Semi-structured interviews	Results describe physiotherapists’ perceptions of patient-centered goals related to successful home based stroke rehabilitation.
Josephson, Woodwad-Kron, Delant, and Hiller, 2015	Discourse analysis, Appraisal theory. Video- or audio recorded consultations	Examine how therapists and patients evaluate aspects such as physical capacity, sensation, and emotions within the physiotherapy consultation	18 consultations Primary care & hospital rehabilitation	N.A.	Video- and audio recorded data	Results describe different aspects of interaction in physiotherapy goal setting.
Kasven-Gonzales, Souverain, and Miale, 2010	Case study	Describe rehabilitation intervention with a woman diagnosed with osteosarcoma and leukemia during the final stage of her life	1 patient with cancer, physiotherapist Terminal care	N.A.	N.A.	Describes and discusses occupational and physiotherapists work with a critically-ill patient to create person-centered realistic and meaningful goals
Kersten et al., 2015	Pilot, mixed methods: randomized controlled trial and interviews	To test the feasibility and acceptability of this specific implementation intention strategy, If-then plans.	10 patients with MS, 10 patients with stroke, 4 physiotherapists Out-patient rehabilitation; in the home setting	If-then plans	Focus group and individual interviews with patients and physiotherapists. Pre-post evaluation: physical functioning and self-reported health status	Results section describes participants experiences of setting activity goals for their self-managed rehabilitation and the feasibility of if-then plans to bridge the goal intention–action gap
Langford et al, 2015	Pilot; a parallel 1:1 randomized controlled feasibility study	To test feasibility of the planned design, the interventions, and the outcome measures, and to facilitate a power calculation for a future randomized controlled trial to improve adherence to recovery goals following hip fracture	Community-dwelling adults over 60 years of age with a recent hip fracture Post-discharge	Education, telephone coaching	Feasibility, specifically recruitment and retention of participants. EQ5D-5L, gait speed, and ICEpop CAPability and the HAD Scale	Describes and evaluates a person-centered education program with mobility recovery goal setting in older adults with recent hip fractures.
Leach, Cornwell, Fleming, and Haines, 2010	Qualitative analysis. Semi-structured email interviews.	To describe current practices in goal-setting within a subacute rehabilitation setting from the perspective of therapists	Physiotherapists (and occupational and speech therapists) Sub-acute stroke rehabilitation	N.A.	Semi-structured interviews	Results describe rehabilitation professionals’ experiences of the goal setting process and quality of patient input.
Lloyd, Roberts, and Freeman, 2014	Constructivist grounded theory. Semi-structured interviews.	To explore physiotherapists’ perceptions about involving patients in goal setting	9 physiotherapists Sub-acute stroke rehabilitation	N.A.	Interviews	Results describe physiotherapists’ perceptions of goal setting in collaboration with patients.
Mudge, Stretton, and Kayes, 2014	Autoethnographic approach	To understand our shared conflicting responses and discomfort to person-centered rehabilitation	2 physiotherapists Neurorehabilitation	N.A.	Independent written reflections and joint discussions	Results describe physiotherapists’ perception of discomfort in person-centered goal setting in rehabilitation.
Oosting et al., 2018	Qualitative case study	To get insight into personal meaning of a person involved in a physical therapy intervention	A old women, her daughter and physiotherapist Before total hip arthroplasty	N.A.	Narrative method	Results describes differences in goals between patient and physiotherapist and how this can help applying patient centered goal setting
Peirone, Goria, and Anselmino, 2014	Randomized controlled trial	To evaluate the safety, feasibility and effectiveness of a dual-task home-based rehabilitation on balance impairments after acquired brain injury	16 patients post-acquired brain injury Out-patient rehabilitation	50-minutes individualized traditional physiotherapy sessions three times a week for seven weeks. The intervention group also performed an individualized dual-task home-based program, six days a week for seven weeks	Balance Evaluation System Test, Activities-specific Balance Confidence Scale and Goal Scaling	Evaluates a rehabilitation program in which the participant, together with their physiotherapist, identified two goals that were realistic and of interest to the participant.
Randall and McEwen, 2000	Perspectves	Provide a definition of patient-centered functional goals	N.A.	N.A.	N.A.	The perspective describes a patient-centered functional approach to goal writing that are individually meaningful to patients.
Stevens et al., 2016	Qualitative descriptive design. Observations and interviews.	To get insight into the patient’s perspective about the feasibility of the PSC	23 physiotherapy sessions, 23 patients with chronic conditions Community rehabilitation	PSC instrument into daily practice.	Observations and interviews	Results describe aspects of patient involvement in goal negotiation and tailoring of goals in physiotherapy, from the therapist perspective.
Stevens, Köke, van der Weijden, and Beurskens, 2017a	A non-controlled intervention study	To examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method.	218 patients and 51 physiotherapists Community-based health care	PSC instrument into daily practice.	Quantitative and qualitative data by recording consultations and assessing patient files, questionnaires and written reflection reports	Results describe patients’ experiences of their involvement and participation in physiotherapy goal setting.
Stevens et al., 2017	Directed content analysis. Observations and interviews.	To examine physiotherapy goal-setting and the use of the PSC and physiotherapists’ perception of the usefulness of the PSC	23 patients and 10 physiotherapists Chronic conditions	PSC instrument into daily practice.	Audio-tapes and semi-structured interviews	Results describes physiotherapists experiences of patient-specific instruments to support patient involvement in the goal-setting process
Stevens, Köke, van der Weijden, and Beurskens, 2017b	Development study with a user-centered design	To improve the Patient-Specific Complaints instrument	Patients and physiotherapists	N.A.	Expert group meeting, questionnaires, field testing feedback	Results describe the process to improve an instrument for involving patients in goal setting,
Thomson, 2008	Ethnographic study	To explore how therapist/patient interactions influence success or contribute to meeting the patients’ goals on a pain management program	A team of 5 physiotherapist Hospital	N.A.	Observations	Results describes physiotherapists interactions with patients to outline and meet the patients’ treatment goals.

Figure 1. Flow-chart of data extraction.

Figure 2. Initial framework for how person-centered goal-setting could be conceptualized and operationalised in physiotherapy.

Table

Date	Database	Search terms			Hits
2018–02-02	Cinahl	goal setting	physiotherapy	person-center*	0
		goal setting	physiotherapy	person-center*	0
		goal setting	physiotherapy	patient-center*	6
		goal setting	physiotherapy	patient-center*	4
		goal setting	physiotherapy	client-center*	0
		goal setting	physiotherapy	client-center*	0
		goal setting	physical therapy	person-center*	0
		goal setting	physical therapy	person-center*	0
		goal setting	physical therapy	patient-center*	6
		goal setting	physical therapy	patient-center*	2
		goal setting	physical therapy	client-center*	0
		goal setting	physical therapy	client-center*	0
				Total	8
2018–02-02	Pubmed	goal setting	physiotherapy	person-center*	5
		goal setting	physiotherapy	person-center*	3
		goal setting	physiotherapy	patient-center*	16
		goal setting	physiotherapy	patient-center*	11
		goal setting	physiotherapy	client-center*	6
		goal setting	physiotherapy	client-center*	3
		goal setting	physical therapy	person-center*	5
		goal setting	physical therapy	person-center*	3
		goal setting	physical therapy	patient-center*	35
		goal setting	physical therapy	patient-center*	10
		goal setting	physical therapy	client-center*	8
		goal setting	physical therapy	client-center*	4
				Total	74
2018–02-03	PEDro	goal setting	physiotherapy	person-center	0
		goal setting	physiotherapy	person-center	0
		goal setting	physiotherapy	patient-center	1
		goal setting	physiotherapy	patient-center	0
		goal setting	physiotherapy	client-center	0
		goal setting	physiotherapy	client-center	0
		goal setting	physical therapy	person-center	0
		goal setting	physical therapy	person-center	0
		goal setting	physical therapy	patient-center	3
		goal setting	physical therapy	patient-center	0
		goal setting	physical therapy	client-center	0
		goal setting	physical therapy	client-center	0
				Total	3
2018–02-03	REHABDATA	goal setting	physiotherapy	person-center	0
		goal setting	physiotherapy	person-center	0
		goal setting	physiotherapy	patient-center	0
		goal setting	physiotherapy	patient-center	0
		goal setting	physiotherapy	client-center	0
		goal setting	physiotherapy	client-center	0
		goal setting	physical therapy	person-center	0
		goal setting	physical therapy	person-center	0
		goal setting	physical therapy	patient-center	0
		goal setting	physical therapy	patient-center	0
		goal setting	physical therapy	client-center	0
		goal setting	physical therapy	client-center	0
				Total	0
2018–02-03	PsycINFO	goal setting	physiotherapy	person-center*	0
		goal setting	physiotherapy	person-center*	1
		goal setting	physiotherapy	patient-center*	5
		goal setting	physiotherapy	patient-center*	5
		goal setting	physiotherapy	client-center*	3
		goal setting	physiotherapy	client-center*	4
		goal setting	physical therapy	person-center*	4
		goal setting	physical therapy	person-center*	3
		goal setting	physical therapy	patient-center*	16
		goal setting	physical therapy	patient-center*	6
		goal setting	physical therapy	client-center*	16
		goal setting	physical therapy	client-center*	3
				Total	43
2018–02-03	Scopus	goal setting	physiotherapy	person-center*	2
		goal setting	physiotherapy	person-center*	2
		goal setting	physiotherapy	patient-center*	8
		goal setting	physiotherapy	patient-center*	8
		goal setting	physiotherapy	client-center*	4
		goal setting	physiotherapy	client-center*	4
		goal setting	physical therapy	person-center*	1
		goal setting	physical therapy	person-center*	1
		goal setting	physical therapy	patient-center*	6
		goal setting	physical therapy	patient-center*	6
		goal setting	physical therapy	client-center*	1
		goal setting	physical therapy	client-center*	1
				Total	15

Table

	de Vries et al., 2016	Kersten et al., 2015	Langford et al., 2015	Peirone, Goria, and Anselmino, 2014
1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT?	Yes	Yes	Yes	Yes
2. Was the method of randomization adequate (i.e., use of randomly generated assignment)?	Yes	Yes	Yes	Yes
3. Was the treatment allocation concealed (so that assignments could not be predicted)?	Yes	Yes	Yes	Yes
4. Were study participants and providers blinded to treatment group assignment?	Yes	No	No	No
5. Were the people assessing the outcomes blinded to the participants’ group assignments?	Yes	Yes	Yes	Yes
6. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?	Yes	Yes	Yes	Yes
7. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?	Yes	No	Yes	Yes
8. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?	Yes	Yes	No	Yes
9. Was there high adherence to the intervention protocols for each treatment group?	Yes	Yes	Yes	Yes
10. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?	Not reported	Yes	Yes	Not reported
11. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?	Yes	Yes	Yes	Yes
12. Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?	Yes	No	No	No
13. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyzes were conducted)?	Yes	Yes	Yes	Yes
14. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?	Yes	Yes	No	Yes
Quality rating	Good N = 64 + 66	Fair Pilot-study, N = 10 + 10	Fair Feasibility-study, pilot N = 11 + 15	Fair Pilot-study N = 8 + 8

Table

	de Vries et al., 2015	Gardner et al 2015	Stevens, Köke, van der Weijden, and Beurskens, 2017aa
1. Was the study question or objective clearly stated?	Yes	Yes	Yes
2. Were eligibility/selection criteria for the study population prespecified and clearly described?	Yes	No	Yes
3. Were the participants in the study representative of those who would be eligible for the test/service/intervention in the general or clinical population of interest?	No	No	Yes
4. Were all eligible participants that met the prespecified entry criteria enrolled?	No	Cannot determine	No
5. Was the sample size sufficiently large to provide confidence in the findings?	No	No	Yes
6. Was the test/service/intervention clearly described and delivered consistently across the study population?	Yes	Yes	Yes
7. Were the outcome measures prespecified, clearly defined, valid, reliable, and assessed consistently across all study participants?	Yes	Yes	Yes
8. Were the people assessing the outcomes blinded to the participants’ exposures/interventions?	No	Not reported	No
9. Was the loss to follow-up after baseline 20% or less? Were those lost to follow-up accounted for in the analysis?	Yes	No	Yes
10. Did the statistical methods examine changes in outcome measures from before to after the intervention? Were statistical tests done that provided p values for the pre-to-post changes?	Yes	No	Yes
11. Were outcome measures of interest taken multiple times before the intervention and multiple times after the intervention (i.e., did they use an interrupted time-series design)?	No	No	No
12. If the intervention was conducted at a group level (e.g., a whole hospital, a community, etc.) did the statistical analysis take into account the use of individual-level data to determine effects at the group level?	Not applicable	Not applicable	Not applicable
Quality rating	Fair Pilot-study N = 12 pat+ 2 PT	Fair N = 20	Good Process evaluation N = 218 pat+51 PT

Table

	Deutsch, Maidan, and Dickstein, 2012	Kasven-Gonzales, Souverain, and Miale, 2010
1. Was the study question or objective clearly stated?	Yes	Yes
2. Was the study population clearly and fully described, including a case definition?	Yes	Yes
3. Were the cases consecutive?	Not applicable	Not applicable
4. Were the subjects comparable?	Not applicable	Not applicable
5. Was the intervention clearly described?	Yes	Yes
6. Were the outcome measures clearly defined, valid, reliable, and implemented consistently across all study participants?	Yes	Cannot determine
7. Was the length of follow-up adequate?	Yes	Yes
8. Were the statistical methods well-described?	N.A	Not applicable
9. Were the results well-described?	Yes	Yes
Quality rating	Good	Good

Table

	Cameron,	Josephson, Woodwad-Kron, Delant, and Hiller, 2015	Hale and Piggot, 2005	Leach, Cornwell, Fleming, and Haines, 2010	Lloyd et al 2014
1. Was there a clear statement of the aims of the research?	Yes	Yes	Yes	Yes	Yes
2. Is qualitative methodology appropriate?	Yes	Yes	Yes	Yes	Yes
3. Was the research design appropriate to address the aims of the research?	Yes	Yes	Yes	Can’t tell	Yes
4. Was the recruitment strategy appropriate to the aims of the research?	Yes	Can’t tell	Yes	Yes	Yes
5. Was the data collected in a way that addressed the research issue?	Yes	Can’t tell	Yes	No	Yes
6. Has the relationship between researcher and participant been adequately considered?	No	Yes	Yes	No	Yes
7. Have ethical issues been taken into consideration?	Can’t tell	Yes	Yes	Yes	Can’t tell
8. Was the data analysis sufficiently rigorous?	Yes	Yes	Yes	Yes	Yes
9. Is there a clear statement of findings?	Yes	Yes	Yes	Yes	Yes
10. How valuable is the research?	Valuable	Valuable	Valuable	Moderate	Valuable
	Mudge, Stretton, and Kayes, 2014	Oosting et al., 2018	Stevens et al., 2016	Stevens, Köke, van der Weijden, and Beurskens, 2017bb	Thomson, 2008
1. Was there a clear statement of the aims of the research?	Yes	Yes	Yes	Yes	Yes
2. Is qualitative methodology appropriate?	Yes	Yes	Yes	Yes	Yes
3. Was the research design appropriate to address the aims of the research?	Yes	Yes	Yes	Yes	Yes
4. Was the recruitment strategy appropriate to the aims of the research?	Yes	Can’t tell	Yes	Yes	Can’t tell
5. Was the data collected in a way that addressed the research issue?	Yes	Yes	Yes	Yes	Yes
6. Has the relationship between researcher and participant been adequately considered?	Can’t tell	Yes	Yes	No	Yes
7. Have ethical issues been taken into consideration?	No	Yes	No	No	Yes
8. Was the data analysis sufficiently rigorous?	Yes	Yes	Yes	Yes	Yes
9. Is there a clear statement of findings?	Yes	Yes	Yes	Yes	Yes
10. How valuable is the research?	Valuable	Valuable	Valuable	Valuable	Valuable

Cameron L, Somerville1 L, Naismith C, Watterson D, Maric V, Lannin N 2018 A qualitative investigation into the patient-centered goal-setting practices of allied health clinicians working in rehabilitation. Clinical Rehabilitation 32: 827–840.

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de Vries NM, van Ravensberg CD, Hobbelen JS, van der Wees PJ, Olde Rikkert MG, Staal JB, Nijhuis-van der Sanden MW 2015 The Coach2Move approach: Development and acceptability of an individually tailored physical therapy strategy to increase activity levels in older adults with mobility problems. Journal of Geriatric Physical Therapy 38: 169–182.

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de Vries NM, Staal JB, van der Wees PJ, Adang EM, Akkermans R, Olde Rikkert MG, Nijhuis-van der Sanden MW 2016 Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: A randomized controlled trial with 6 months follow-up. Journal of Cachexia Sarcopenia Muscle 7: 422–435.

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Deutsch JE, Maidan I, Dickstein R 2012 Patient-centered integrated motor imagery delivered in the home with telerehabilitation to improve walking after stroke. Physical Therapy 92: 1065–1077.

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Gardner T, Refshauge K, McAuley J, Goodall S, Hübscher M, Smith L 2015 Patient led goal setting in chronic low back pain - What goals are important to the patient and are they aligned to what we measure? Patient Education and Counseling 98: 1035–1038.

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Hale LA, Piggot J 2005 Exploring the content of physiotherapeutic home-based stroke rehabilitation in New Zeeland. Archives of Physical Medicine and Rehabilitation 86: 1933–1940.

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Josephson I, Woodwad-Kron R, Delant C, Hiller A 2015 Evaluative language in physiotherapy practice: How does it contribute to the therapeutic relationship? Social Science and Medicine 143: 128–136.

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Kasven-Gonzales N, Souverain R, Miale S 2010 Improving quality of life through rehabilitation in palliative care: case report. Palliative and Supportive Care 8: 359–369.

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Kersten P, McPherson KM, Kayes NM, Theadom A, McCambridge A 2015 Bridging the goal intention-action gap in rehabilitation: A study of if-then implementation intentions in neurorehabilitation. Disability and Rehabilitation 37: 1073–1081.

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Langford DP, Fleig L, Bron KC, Cho NJ, Ledoyen M, Legn J, Panagiotopoulos K, Sharpe N, Asche MC 2015 Back to the future - Feasibility of recruitment and retention to patient education and telephone follow-up after hip fracture: A pilot randomized controlled trial. Patient Preference and Adherence 22: 1343–1351.

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Leach E, Cornwell P, Fleming J, Haines T 2010 Patient centered goal-setting in a subacute rehabilitation setting. Disability and Rehabilitation 32: 159–172.

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Lloyd A, Roberts AR, Freeman JA 2014 ‘Finding a balance’ in involving patients in goal setting early after stroke: a physiotherapy perspective. Physiother Research International 19: 147–157.

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Mudge S, Stretton C, Kayes N 2014 Are physiotherapists comfortable with person-centred practice? An autoethnographic insight. Disability and Rehabilitation 36: 457–463.

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Oosting E, Dronkers J, Hoogeboom T, van Meeteren N, Speelman WM 2018 Personal meaning in relation to daily functioning of a patient in physical therapy practice: Narratives of a patient, a family member, and physical therapist. Disability and Rehabilitation 40: 1220–1226.

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Peirone E, Goria PF, Anselmino A 2014 A dual-task home-based rehabilitation programme for improving balance control in patients with acquired brain injury: A single-blind, randomized controlled pilot study. Clinical Rehabilitation 28: 329–338.

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Randall KE, McEwen IR 2000 Writing patient-centered functional goals. Physical Therapy 80: 1197–1203.

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Stevens A, Moser A, Koke A, van der Weijden T, Beurskens A 2016 The patient’s perspective of the feasibility of a patient-specific instrument in physiotherapy goal setting: A qualitative study. Patient Preference and Adherence 10: 425–434.

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Stevens A, Köke A, van der Weijden T, Beurskens A 2017a Ready for goal setting? Process evaluation of a patient-specific goal-setting method in physiotherapy. BMC Health Service Research 17: 618.

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Stevens A, Moser A, Köke A, van der Weijden T, Beurskens A 2017 The use and perceived usefulness of a patient specific measurement instruments in physiotherapy goal setting. A Qualitative Study. Musculoskeletal Science and Practice 27: 23–31.

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Stevens A, Köke A, van der Weijden T, Beurskens A 2017b The development of a patient-specific method for physiotherapy goal setting: A user-centered design. Disability and Rehabilitation 40: 2048–2055.

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Thomson D 2008 An ethnographic study of physiotherapists’ perceptions of their interactions with patients on a chronic pain unit. Physiotherapy Theory and Practice 24: 408–422.

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