Impacts of goal setting on engagement and rehabilitation outcomes following acquired brain injury: a systematic review of reviews

Figures & data

Table 1. Key concepts and definitions.

Acquired brain injury (ABI)	any damage to the brain which is not present at birth and does not occur from a congenital or a degenerative disease but includes for example traumatic brain injury (TBI) or stroke [39].
Client-centered practice	“…is a partnership between the client and the therapist that empowers the client to engage in functional performance and fulfil his or her occupational roles in a variety of environments. The client participates actively in negotiating goals which are given priority and are at the centre of assessment, intervention and evaluation. Throughout the process the therapist listens to and respects the client’s values, adapts the interventions to meet the client’s needs and enables the client to make informed decisions.” [6, p.308]
Goal-setting	“the establishment or negotiation of rehabilitation goals” [5,p.402]. A rehabilitation goal refers to “a desired future state to be achieved by a person with a disability as a result of rehabilitation activities” [5, p.402].
Occupational performance	interactions between people, their occupations or activities performed, roles and environments in which they act [40].
Participation	engagement in meaningful life situations that are part of an individual’s sociocultural context and either desired or necessary for their well-being [35].
Patient engagement in health programs	“a gradual process of connection between the healthcare provider and patient, and an internal state, which may be accompanied by observable behaviors indicating engagement” [2, p.643].

Figure 1. Flowchart for article selection.

Table 2. Overview of reviewed articles.

Author and research design(s)	Aim	Participants	Intervention	Results	Evidence	CASP/OCEBM
Levack et al. [11] 19 RCT studies: 6^a studies mainly related to disorders or injuries of the central nervous system	To determine the evidence regarding the effectiveness of goal planning in clinical rehabilitation	Patients with neurological, psychiatric, musculoskeletal, cardiovascular, respiratory and dietary/endocrine disorders. 309 patients^a (some^a patients possibly in several studies) with brain injuries or stroke, 47 patients with orthopedic injuries	Day treatment (n = 16) Provision of goals Goal management training (n = 30)	Some^a limited evidence was identified that goal planning can influence ABI patients’ adherence to treatment regimens and strong evidence that prescribed, specific, challenging goals can improve immediate patient performance in some specific clinical contexts.	4^a high quality studies. See results.	CASP 7/10 OCEBM level 1
Rosewilliam et al. [12] 27 studies: 18 qualitative, 8 quantitative, and 1 mixed-methods	To map out extent and effects of application of patient-centered goal setting in stroke rehabilitation practice	Acute to community stroke rehabilitation clients. Numbers not clearly stated: patients minimum 331 (exact number of stroke patients not defined); professionals minimum 83; carers 16	Patient-centered goal setting	Some benefit with psychological outcomes. Patient-centered goal setting is minimally adopted.	Mostly weak methodologies of included studies	CASP 6,5/10 OCEBM level 2
Sugavanam et al. [10] 17 studies: 7 quantitative (cohort/retrospective cohort) 10 qualitative (experiences)	To integrate and appraise evidence for effects of goal setting in stroke rehabilitation	Stroke patients: 614 Professionals: 43 Carers: 38	Seven studies used a form of goal setting and evaluated its effects	No firm conclusions could be made on the effectiveness, feasibility and acceptability of goal setting.	Mostly weak to moderate methodological strengths (includes 3 single case studies). Qualitative methods through interviews or Likert scale responses	CASP 6,5/10 OCEBM level 2
Wheeler et al. [13] 35 studies: (2 of them related to goal directed therapy^b)	To evaluate the effectiveness of interventions to improve performance for people with psychosocial, behavioral, or emotional impairments after traumatic brain injury	Patients with traumatic brain injury: 84^b	Goal directed intervention(s)	Strong evidence: goal-directed interventions in outpatient settings improves participant self-ratings of performance and satisfaction. Moderate evidence: goal-directed outpatient rehabilitation after TBI improves goal attainment, occupational performance, psychosocial integration and adjustment levels and combined with group therapy increases life satisfaction	Included studies are level I–III Level I^b (goal directed therapy)	CASP 7,5/10 OCEBM level 2

CASP: Critical Appraisal Skills Programme; OCEBM: the Oxford Centre for Evidence Based Medicine; N: number.

^a Studies where the population was mostly individuals with disorders or injuries of the central nervous system.

^b Studies related to goal directed therapy.

Table 3. CASP quality rating.

	1	2	3	4	5	6	7	8	9	10	Quality rating %	OCEBM level
Levack et al. [11]	Y	Y	P	Y	Y	P	N	P	P	Y	70	1
Rosewilliam et al. [12]	Y	P	P	P	Y	P	N	Y	P	Y	65	2
Sugavanam et al. [10]	Y	Y	Y	Y	Y	P	N	P	P	P	70	2
Wheeler et al. [13]	Y	Y	Y	P	Y	P	P	P	Y	P	75	2

(1) A clearly focused question? (2) The right type of papers? (3) All, relevant studies were included? (4) Enough done to assess the quality of the included studies? (5) If the results of the review have been combined, was it reasonable to do so? (6) The overall results of the review? (7) How precise are the results? (8) Can the results be applied to the local population? (9) Were all important outcomes considered? (10) Are the benefits worth the harms and costs? OCEBM: Oxford Centre for Evidence Based Medicine; Y: yes; P: partial/unclear; N: no.

Figure 2. Model for considering factors influencing goal setting, engagement, and outcomes of rehabilitation.

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Sugavanam T, Mead G, Bulley C, et al. The effects and experiences of goal setting in stroke rehabilitation – a systematic review. Disabil Rehabil. 2013;35(3):177–190.

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