Older rehabilitees’ life-course agency in Finnish gerontological rehabilitation

Aims: This study investigates gerontological rehabilitation sessions of Finnish rehabilitees in the framework of life-course agency from the perspectives of temporal orientation and agency. Methods: The research data were obtained by non-participatory observation in 11 individual goal-setting sessions between 11 rehabilitees and their personal counsellors. The data were analysed in accordance with data-driven, qualitative content and narrative analysis, with an emphasis on the life-course agency approach. Results: Four temporal orientations of older rehabilitees were identified in the rehabilitation sessions: (i) timeless, (ii) past, (iii) present, and (iv) life course. For each temporal orientation, the rehabilitees displayed different kinds of agency. Fractured agency was intertwined with the timeless orientation, frozen agency was related to the past orientation, practical agency to the present orientation, and transitional agency emerged in relation to the life-course orientation. Conclusions: The article contributes to the discussion of how older adults’ rehabilitation should be reformed within the Finnish context. The study suggests that a person-centred gerontological rehabilitation process should be conceptualized in terms of an agency-based approach with a personally constructed and temporally embedded life-course perspective. This kind of conceptualizing could promote empowered cooperation and innovative interventions with flexible schedules in the rehabilitation processes of older adults.     

Research Digest

A single-blind within-subjects trial was used to test the efficacy of sending SMS text messages to patients with a traumatic brain injury as a means of improving their recall of rehabilitation goals. Eleven participants were recruited from two community-based rehabilitation centres and were sent text messages relating to three randomly selected goals from a selection of six current goals three times per day for 14 days. Participants’ recall of their rehabilitation goals was assessed at baseline, seven days, and 14 days via free recall and cued recall procedures. Results showed that goals in the “text” condition were recalled better than goals in the “no text” condition. Practical applications and extensions are discussed.     

Applications of the International Classification of Functioning,Disability and Health in goal-setting practices in healthcare

Abstract

Purpose: While evidence exists to support the adoption of collaborative goal-setting in healthcare, some clinicians feel that it is not feasible. This article proposes that the development of a standardized collaborative goal-setting approach using the framework and classification system of the International Classification of Functioning, Disability and Health (ICF) could address these feasibility issues. It is the objective of this article to understand the extent to which the ICF has been integrated into current goal-setting literature in order to assess its potential use in a standardized collaborative goal-setting approach. Methods: A scoping review of the literature published in English since 2001 was conducted in EMBASE, Medline and CINAHL. Articles were included in this review if they integrated the ICF into goal-setting practices in any healthcare discipline. Results: Nineteen articles were included in this review. Analysis of these articles revealed that the ICF has been integrated into goal-setting practices. The benefits associated with this integration suggest that integrating the ICF into goal-setting practices can standardize collaborative goal-setting. Conclusion: Evidence from this scoping review supports the use of the ICF in healthcare goal-setting practices because it provides clinicians and patients with specific steps to follow when attempting to set goals collaboratively.

• Implications for Rehabilitation

• Collaborative goal-setting.

• Collaborative goal-setting involves patients working with their clinicians to develop health outcome goals together and is a fundamental component of patient-centered care.

• Some rehabilitation disciplines have yet to fully embrace collaborative goal-setting due to feasibility issues.

• This article proposes that the integration of the International Classification of Functioning, Disability and Health (ICF) into goal-setting practices could standardize collaborative goal-setting in a way that would address these feasibility issues.

     

Patient centered goal-setting in a subacute rehabilitation setting

Purpose.?The purpose of this research is to describe current practices in goal-setting within a subacute rehabilitation setting from the perspective of therapists representing the disciplines of occupational therapy, speech pathology and physiotherapy.

Method.?Qualitative semi-structured email interviews were conducted with therapists from the Geriatric Assessment and Rehabilitation Unit of an Australian hospital. Therapists were required to respond to questioning with reference to identified rehabilitation patients with stroke.

Results.?Three approaches to goal-setting were identified: therapist controlled, therapist led and patient centred. Goals aimed at the ICF levels of impairment and activity limitations were predominant. Barriers to a patient centered goal-setting approach largely outweighed facilitators. Potential successful resolutions were offered to overcome these barriers.

Conclusions.?The inability of patients to participate fully in the goal-setting process largely determines the approach taken by therapists. This influences the level of patient centeredness incorporated into the goal-setting process. Goals expressed at the level of impairment, by therapists, may be stepping stones to perceived patient goals at the levels of activity and participation. Barriers to a patient centered approach can be overcome through education of the patient and family regarding the nature of the injury and modification of communication between therapist and patient.     

A clinical decision framework for the identification of main problems and treatment goals for ambulant children with bilateral spastic cerebral palsy

The primary aim of the study was to investigate how a clinical decision process based on the International Classification of Function, Disability and Health (ICF) and the Hypothesis-Oriented Algorithm for Clinicians (HOAC-II) can contribute to a reliable identification of main problems in ambulant children with cerebral palsy (CP). As a secondary aim, to evaluate how the additional information from three-dimensional gait analysis (3DGA) can influence the reliability.Twenty-two physical therapists individually defined the main problems and specific goals of eight children with bilateral spastic CP. In four children, the results of 3DGA were provided additionally to the results of the clinical examination and the GMFM-88 (gross motor function measure-88). Frequency analysis was used to evaluate the selected main problems and goals. For the main problems, pair-wise agreement was calculated by the number of corresponding problems between the different therapists and using positive and negative agreement per problem. Cluster analysis using Ward's method was used to evaluate correspondence between the main problems and specific goals.The pair-wise agreement revealed frequencies of 47%, 32% and 3% for the identification of one, two or three corresponding main problems. The number of corresponding main problems was higher when additional information of 3DGA was provided. Most of the specific goals were targeting strength (34%), followed by range of motion (15.2%) and GMFM-D (11.8%). In 29.7% of the cases, therapists could not prioritize and exceeded the number of eight specific goals. Cluster analysis revealed a logic connection between the selection of strength as a main problem and as specific goal parameters. Alignment as a main problem was very often associated with specific parameters like ROM and muscle length and with hypertonia as a main problem.The results show a moderate agreement for the selection of main problems. Therapists are able to use the proposed model for a logic and structured clinical reasoning. Setting priorities in the definition of specific goals is revealed as a remaining difficulty. Further research is required to investigate the additional value of 3DGA and to improve priority setting.     

Performance goals of runners are associated with the occurrence of running-related injuries

ObjectiveThe aim of this study was to evaluate the relationship between running performance goals and running-related injuries (RRIs).DesignRetrospective cross-sectional study.SettingA total of 970 recreational runners filled in an online questionnaire to collect data on personal characteristics, their running activities, RRIs, and running goals.Participants970 recreational runners, 1) without a running performance goal, who 2) trained to complete a certain distance, and who 3) trained to complete a certain distance and to participate in a specific running event.Main outcome measuresRRI, defined as any physical complaint developed during running in the previous 12 months.ResultsA statistically significant relationship was found between runners who trained for a specific running event and who also wanted to run a certain distance (OR 2.0, 95%CI 1.23–2.98) compared with runners without a running goal. (Hinder from a) Previous injury (OR 3.9, 95%CI 2.79–5.42), overweight (OR 1.6, 95%CI 1.10–2.21), and training for more than 22.5 h/year (OR 1.7, 95%CI 1.04–2.72 and OR 2.3, 95%CI 1.42–3.81) were also associated with RRIs.ConclusionRunning to achieve running goals, specifically running to complete a certain distance and to participate in an event, is associated with the occurrence of an RRI.     

The role of non-clinicians in a goal setting model for the management of allergic rhinitis in community pharmacy settings

Objective

To test the relative effects of a clinician versus non-clinician delivered goal setting intervention to assist patients presenting with Intermittent Allergic Rhinitis (IAR) in community pharmacies.

Methods

A 10-day mixed-method, parallel group repeated measures study was conducted in Sydney. Clinicians (pharmacists) and non-clinicians (pharmacy assistants) recruited patients suffering IAR. Intervention group pharmacy staff delivered a brief structured goal setting intervention to support IAR patient self-management whilst the control group delivered standard care.

Results

One hundred and fifty participants (N = 77 intervention; N = 73 control) were recruited at 20 community pharmacies. Both groups significantly improved on all outcome measures when assisted by either clinicians or non-clinicians. The intervention group patients supported by non-clinicians made significant improvements in self-efficacy and quality of life compared to the control group supported by non-clinicians. Strategies devised to control IAR triggers reflected practical actions whereas adherence and dose information strategies addressed IAR symptoms. Adherence did not impact significantly on self-reported symptom severity.

Conclusion

Both clinicians and non-clinicians can deliver this service. There is a need for a detailed and practical approach to assist patients towards a goal-directed and autonomous management of IAR.

Practice implications

With training non-clinicians can support patients with IAR, reducing the time constraints and workload for clinicians.     

Goal-setting for behavior change in primary care: An exploration and status report

Objective

This paper explores the behavior change method of goal-setting and reviews the literature on goal-setting in primary care for patients with chronic conditions.

Methods

A literature search was conducted resulting in eight articles meeting the criteria of goal-setting interventions in primary care for adults or adolescents with chronic conditions.

Results

Hypotheses are advanced that goal-setting is generally conducted by collaboratively working with patients to set short-term and specific goals, with follow-up to provide feedback to patients. The articles reviewed generally confirmed these hypotheses. This review did not focus on clinical outcomes, but on the processes of engaging patients in goal-setting discussions.

Conclusion

Evidence that goal-setting is superior to other behavior change methods has not been shown. Since goal-setting is being utilized as a behavior change technique in many primary care sites, primary care practices can benefit from information on how best to implement this innovation.

Practice Implications

Generally, clinicians are minimally involved in goal-setting discussions with their patients. Engaging patients in goal-setting can be done with interactive computer programs and non-clinical members of the primary care team.     

Assessing the effectiveness of a goal-setting session as part of a structured group self-management education programme for people with type 2 diabetes

Objectives

To measure the number of people who have identified a behaviour change goal and completed an action-plan to meet their goal on completion of a diabetes self-management education programme (DSME) and level of success in sustaining their action-plan. The DSME people attended was Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND).

目标管理护理干预模式在老年慢性阻塞性肺疾病患者中的应用

目的：探讨目标管理护理干预模式对老年慢性阻塞性肺疾病患者睡眠质量、心理健康状况、肺功能及疾病自我护理能力的影响。方法：选取2020年1月至2021年6月收治的110例老年慢性阻塞性肺疾病患者,分为对照组和干预组各55例。对照组患者应用常规护理模式,干预组患者应用目标管理护理干预模式,两组护理周期均为2个月。采用重复测量方差分析法比较两组护理前、护理1个月、护理2个月后睡眠质量、心理健康状况得分差异性。采用卡方检验,独立样本t检验比较两组护理2个月后肺功能和自我护理能力的得分差异。结果：护理前,两组的匹兹堡睡眠质量指数,汉密尔顿焦虑量表和抑郁量表评分差异均无统计学意义（P>0.05）。护理1个月、2个月后,干预组匹兹堡睡眠质量指数,汉密尔顿焦虑量表和抑郁量表评分均低于对照组,差异有统计学意义（P<0.05）。两组的匹兹堡睡眠质量指数,汉密尔顿焦虑量表和抑郁量表评分均随干预时间的变化而变化,干预方法与干预时间之间存在交互效应（P<0.05）。此外,护理2个月后,干预组肺功能分级<Ⅲ级率及疾病自我护理能力评分高于对照组,差异有统计学意义（P<0.05）。结论：目...