https://orcid.org/0000-0003-3727-1149
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Abstract
Purpose
Spinal cord injury is a complex condition requiring long-term rehabilitation. Goal-setting is considered an essential part of rehabilitation, however, knowledge of how goal-setting is practised across health-care professions, settings and diagnoses are scarce. The purpose of the study was therefore to explore health-care professionals’ perspectives on goal-setting practice in outpatient multidisciplinary rehabilitation targeting patients with spinal cord injury.
Materials and methods
An anthropological study combining participant-observation and focus group interviews. Data were analysed using reflexive thematic analysis. COREQ checklist was used to report the study quality.
Results
Health-care professionals experienced a field of tension between internationally recommended goal-setting criteria, requiring goals to be specific, measurable, realistic and time-based, and a practice influenced by patients presenting complex needs. The challenges were managed using a negotiation strategy characterized by a tinkering approach to adjust notions of measurability, realism and time frame into practice. Also, health-care professionals were challenged in relation to practising a person-centred rehabilitation approach.
Conclusions
We suggest rethinking the goal-setting process by allowing recommended goal-setting criteria to be adapted to a specific practice context while acknowledging goal-setting practice in its variety and flexibility as a strength. Furthermore, improved incorporation of patients’ perspectives in the practice is needed.
To strengthen person-centred rehabilitation practice, clinicians should actively search for and engage patient-identified needs and preferences in shared goal-setting.
Standard criteria of goal-setting should comply with the individual and specific participation in the everyday life of patients with SCI.
SMART goals are not always the right way to formulate rehabilitation goals.
A flexible and pragmatic approach is needed to reach a balance between the patients’ complex needs and the recommendations for goals to be specific, measurable, realistic, and time-based.
Implications for rehabilitation
Acknowledgements
The authors thank health-care professionals and patients from the hospital for their willingness to participate in this study and for openly sharing their considerations and experiences.
Disclosure statement
The authors declare no conflicts of interest.