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Review
. 2015 Jul 20;2015(7):CD009727.
doi: 10.1002/14651858.CD009727.pub2.

Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation

William M M Levack  1 , Mark Weatherall, E Jean C Hay-Smith, Sarah G Dean, Kathryn McPherson, Richard J Siegert
Affiliations
Review

Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation

William M M Levack et al. Cochrane Database Syst Rev. .

Abstract

Background: Goal setting is considered a key component of rehabilitation for adults with acquired disability, yet there is little consensus regarding the best strategies for undertaking goal setting and in which clinical contexts. It has also been unclear what effect, if any, goal setting has on health outcomes after rehabilitation.

Objectives: To assess the effects of goal setting and strategies to enhance the pursuit of goals (i.e. how goals and progress towards goals are communicated, used, or shared) on improving health outcomes in adults with acquired disability participating in rehabilitation.

Search methods: We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trials registers to December 2013, together with reference checking, citation searching and contact with study authors to identify additional studies. We did not impose any language or date restrictions.

Selection criteria: Randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs evaluating the effects of goal setting or strategies to enhance goal pursuit in the context of adult rehabilitation for acquired disability.

Data collection and analysis: Two authors independently reviewed search results for inclusion. Grey literature searches were conducted and reviewed by a single author. Two authors independently extracted data and assessed risk of bias for included studies. We contacted study authors for additional information.

Main results: We included 39 studies (27 RCTs, 6 cluster-RCTs, and 6 quasi-RCTs) involving 2846 participants in total. Studies ranged widely regarding clinical context and participants' primary health conditions. The most common health conditions included musculoskeletal disorders, brain injury, chronic pain, mental health conditions, and cardiovascular disease.Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. These studies provide very low quality evidence that including any type of goal setting in the practice of adult rehabilitation is better than no goal setting for health-related quality of life or self-reported emotional status (8 studies; 446 participants; standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.17 to 0.88, indicative of a moderate effect size) and self-efficacy (3 studies; 108 participants; SMD 1.07, 95% CI 0.64 to 1.49, indicative of a moderate to large effect size). The evidence is inconclusive regarding whether goal setting results in improvements in social participation or activity levels, body structure or function, or levels of patient engagement in the rehabilitation process. Insufficient data are available to determine whether or not goal setting is associated with more or fewer adverse events compared to no goal setting.Fourteen studies compared structured goal setting approaches, with or without strategies to enhance goal pursuit, to 'usual care' that may have involved some goal setting but where no structured approach was followed. These studies provide very low quality evidence that more structured goal setting results in higher patient self-efficacy (2 studies; 134 participants; SMD 0.37, 95% CI 0.02 to 0.71, indicative of a small effect size) and low quality evidence for greater satisfaction with service delivery (5 studies; 309 participants; SMD 0.33, 95% CI 0.10 to 0.56, indicative of a small effect size). The evidence was inconclusive regarding whether more structured goal setting approaches result in higher health-related quality of life or self-reported emotional status, social participation, activity levels, or improvements in body structure or function. Three studies in this group reported on adverse events (death, re-hospitalisation, or worsening symptoms), but insufficient data are available to determine whether structured goal setting is associated with more or fewer adverse events than usual care.A moderate degree of heterogeneity was observed in outcomes across all studies, but an insufficient number of studies was available to permit subgroup analysis to explore the reasons for this heterogeneity. The review also considers studies which investigate the effects of different approaches to enhancing goal pursuit, and studies which investigate different structured goal setting approaches. It also reports on secondary outcomes including goal attainment and healthcare utilisation.

Authors' conclusions: There is some very low quality evidence that goal setting may improve some outcomes for adults receiving rehabilitation for acquired disability. The best of this evidence appears to favour positive effects for psychosocial outcomes (i.e. health-related quality of life, emotional status, and self-efficacy) rather than physical ones. Due to study limitations, there is considerable uncertainty regarding these effects however, and further research is highly likely to change reported estimates of effect.

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Conflict of interest statement

SD's position at the University of Exeter Medical School is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health.

RS and WL are co‐editors of Siegert 2014b for which they may receive royalties.

WL has in the past received some financial gifts from health professional organisations in the UK for presenting on the topic of goal setting in rehabilitation (Association of Chartered Physiotherapists Interested in Neurology (2013); University College London (2015)).

KM's funded research (The Health Research Council 2005‐2011) includes a focus on goal setting. AUT University has received payment from the Accident Compensation Corporation (New Zealand) (2010‐2015) for consultancy work advising the Corporation on goals and goal setting.

WL, JHS, and MW are employed as academics by the University of Otago. RS is employed as an academic by AUT University. KM is employed as Chief Executive by the Health Research Council of New Zealand.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Forest plot of comparison: 1 Goal setting (with or without strategies to enhance goal pursuit) versus no goal setting, outcome: 1.1 Health related quality of life or self‐reported emotional status.
3
3
Forest plot of comparison: 1 Goal setting (with or without strategies to enhance goal pursuit) versus no goal setting, outcome: 1.2 Activity ‐ ability.
4
4
Forest plot of comparison: 1 Goal setting (with or without strategies to enhance goal pursuit) versus no goal setting, outcome: 1.3 Engagement in rehabilitation.
5
5
Forest plot of comparison: 2 Structured goal setting (with or without strategies to enhance goal pursuit) versus no structured goal setting, outcome: 2.1 Health related quality of life or self‐reported emotional status.
6
6
Forest plot of comparison: 2 Structured goal setting (with or without strategies to enhance goal pursuit) versus no structured goal setting, outcome: 2.4 Satisfaction with service delivery.
1.1
1.1. Analysis
Comparison 1 Goal setting (with or without strategies to enhance goal pursuit) versus no goal setting, Outcome 1 Health related quality of life or self‐reported emotional status.
1.2
1.2. Analysis
Comparison 1 Goal setting (with or without strategies to enhance goal pursuit) versus no goal setting, Outcome 2 Activity ‐ ability.
1.3
1.3. Analysis
Comparison 1 Goal setting (with or without strategies to enhance goal pursuit) versus no goal setting, Outcome 3 Engagement in rehabilitation.
1.4
1.4. Analysis
Comparison 1 Goal setting (with or without strategies to enhance goal pursuit) versus no goal setting, Outcome 4 Self‐efficacy.
2.1
2.1. Analysis
Comparison 2 Structured goal setting (with or without strategies to enhance goal pursuit) versus no structured goal setting, Outcome 1 Health related quality of life or self‐reported emotional status.
2.2
2.2. Analysis
Comparison 2 Structured goal setting (with or without strategies to enhance goal pursuit) versus no structured goal setting, Outcome 2 Activity ‐ ability.
2.3
2.3. Analysis
Comparison 2 Structured goal setting (with or without strategies to enhance goal pursuit) versus no structured goal setting, Outcome 3 Self‐efficacy.
2.4
2.4. Analysis
Comparison 2 Structured goal setting (with or without strategies to enhance goal pursuit) versus no structured goal setting, Outcome 4 Satisfaction with service delivery.
2.5
2.5. Analysis
Comparison 2 Structured goal setting (with or without strategies to enhance goal pursuit) versus no structured goal setting, Outcome 5 Adverse events (withdrawal due to death, re‐hospitalisation or worsening symptoms).
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Pankow 2000 {published data only}
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Stuifbergen 2003 {published data only}
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References to ongoing studies

ACTRN12609000433202 {published data only}
    1. ACTRN12609000433202. Goals and self regulation skills in brain injury rehabilitation: A randomised clinical trial. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83969.
Arends 2013 {published data only}
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Mansfield 2013 {published data only}
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Novakovic‐Agopian 2012 {published data only}
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Reiser 2012 {published data only}
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References to other published versions of this review

Levack 2012
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