‘We don’t have to do it together’: a qualitative study of physiotherapists’ and patients’ perceptions about collaborative goal setting in Nigeria

ABSTRACT

Background

The adoption of Collaborative Goal Setting (CGS) is limited in most rehabilitation settings in Nigeria despite its recommendations in clinical practice guidelines.

Objective

To explore the perceptions of physiotherapists and patients about CGS at a tertiary healthcare facility in Ibadan, Nigeria.

Methods

We conducted focus group discussions among purposively selected physiotherapists (n = 8) and patients (4 stroke survivors, 3 patients with brain injury) to qualitatively explore their perceptions. Audio-taped discussions were transcribed verbatim and thematically analyzed.

Results

We identified four themes around CGS which were: 1) paternalistic view of goal setting; 2) physiotherapists as goal setters; 3) perceived benefits of collaborative goal setting; and 4) barriers and facilitators to CGS. The physiotherapists articulated goals as expected outcomes from treatment and believed they were better poised and experienced to determine what patients could achieve during each phase of treatment. Patients’ view of goal setting agreed with the physio-therapists’, as they also opined that goal setting is the responsibility of physiotherapists. Time constraint, inadequate knowledge and the inability of patients to appropriately articulate their goals and expectations from treatment were barriers to CGS. Concerns about who to collaborate with when dealing with patients with impaired cognition and/or disorders of consciousness were raised by the physiotherapists. Participants in both groups indicated that education on how to set patient-oriented goals could facilitate CGS.

Conclusions

Though rarely practiced, participants agreed that collaborative goal setting could be beneficial. Both the physiotherapists and patients require education on how to appropriately collaborate in setting goals of rehabilitation.

KEYWORDS:

• Collaborative goal setting
• rehabilitation
• physiotherapy
• stroke
• spinal cord injury

Acknowledgments

The authors acknowledge Dr Afolashade Fakolade of the School of Rehabilitation Therapy, Queen’s University, Canada, and Dr ‘Femi Dipeolu of the Department of Epidemiology, University of Ibadan, for their assistance with the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Interview Guide for Patients

1. How comfortable are you with your physiotherapist?

• Probe: what makes you comfortable with your physiotherapist?

• (2) How freely are you able to discuss your needs from rehabilitation with your physiotherapists?

• (3) Do you think there are roles you would like to play alongside your physiotherapist to help your rehabilitation process?

  • Probes: What are these roles? How could you be assisted to play these roles?

• (4) Would you like to be involved in setting the goals for your rehabilitation?

  • Probe: How would you like to be involved in setting the goals of your rehabilitation?

• (5) What difficulties have you experienced (or are experiencing) in being involved in setting the goals of your rehabilitation?

• (6) How could you be assisted to overcome these difficulties?

• (7) What do you feel would make it easier for you to be involved in setting goals for your rehabilitation alongside your physiotherapist?

• (8) Is there anything else you would like to tell us about partnering with your physiotherapists in setting goals, that are not yet covered in this discussion?

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.