Patient engagement and satisfaction with goal planning: Impact on outcome from rehabilitation

Aim: To examine the relationship between patient/family engagement in goal planning, satisfaction with the goal setting process and associated goal attainment and functional gains during rehabilitation. Method: A prospective cohort analysis of consecutively completed episodes for patients discharged over a 1-year period (January-December 2013) in a specialist neurological rehabilitation service in the UK. Participants were adults (n=83) with neurological disabilities (mean±SD age: 42.8 ±15.0 years; programme length: 98 ± 47 days; male to female ratio: 69:31; diagnosis: brain injury (n=75, 90%), spinal cord injury (n=5, 6%), other neurological conditions (n=3, 4%)). The measures used were sixpoint visual analogue scales to rate goal engagement and goal satisfaction, Goal Attainment Scaling (GAS) and the UK Functional Assessment Measure (UK FIM+FAM). Results: Significant improvements were seen between admission and discharge for patient goal engagement (Mann-Whitney z=-2.2, p=0.027) and satisfaction (z=-2.2, p=0.031). Significant correlations were seen between goal engagement and goal satisfaction for patients on admission (Spearman’s rho 0.41, p=0.03) and for their families on discharge (rho 0.82, p<0.001). Patients’ goal engagement by discharge was strongly correlated with GAS achieved T-scores (rho 0.54, p<0.001) and with functional gain (change in FIM+FAM-Motor subscale rho 0.46, p<0.001). Conclusions: Active involvement of patients and their families in meaningful goal planning is an important component of rehabilitation that is associated with improved goal attainment and better functional outcomes.