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AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONStroke is a leading cause of disability, significantly impacting survivors’ ability to return-to-work (RTW). This study aims to explore the qualitative experiences of stroke survivors and caregivers participating in a work skills training programme. The research objectives are to understand participants’ (i) perceived benefits of the programme, (ii) perceived challenges and drawbacks of the programme, and (iii) suggestions for improvement and future recommendations.Thirteen participants (seven stroke survivors and six caregivers) completed the four-week programme. Data were collected through post-workshop focus group discussions, which was analyzed using thematic analysis.Key perceived benefits identified included communication tools, platform for sharing and support, reflections and shifts in mindset, and goal setting and values exploration. Perceived challenges and drawbacks highlighted were difficulty understanding certain workshop content, technical difficulties, and length of workshop sessions. Suggestions for improvement and future recommendations included assessing capacity and readiness to RTW and customizing content to participant needs.This study provides valuable insights into the experiences of stroke survivors and caregivers in a work skills training programme. While significant benefits were identified, areas for improvement remain. These insights will guide the development of more effective and tailored interventions grounded in participants’ needs and perspectives.Participants benefited from the work skills training programme through learning communication skills, peer support, reflections and mindset shifts, and goal setting and values exploration.Challenges identified included difficulty understanding certain workshop content, technical difficulties, and lengthy workshop sessions.Participants further recommended assessing capacity and readiness to work and customizing workshop content to individual needs for future workshops.These insights will guide the development of more effective, tailored post-stroke rehabilitation interventions grounded in the needs and perspectives of stroke survivors and caregivers.Participants benefited from the work skills training programme through learning communication skills, peer support, reflections and mindset shifts, and goal setting and values exploration.Challenges identified included difficulty understanding certain workshop content, technical difficulties, and lengthy workshop sessions.Participants further recommended assessing capacity and readiness to work and customizing workshop content to individual needs for future workshops.These insights will guide the development of more effective, tailored post-stroke rehabilitation interventions grounded in the needs and perspectives of stroke survivors and caregivers. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONIn the BigMove intervention, people with physical and mental health conditions assess their functioning, set goals, and define action plans to achieve their goals recorded in an e-health application using all categories of the International Classification of Functioning, Disability, and Health (ICF). This study investigates whether data from this application can provide insight into participants’ self-perceived functioning, goals and action plans and observe changes over time.Data from 446 participants were analysed with descriptive statistics to describe self-perceived functioning and the ICF categories related to the 15 most frequently chosen goals. Action plans were analysed using inductive analysis. Changes over time were investigated by comparing assessments before and after at least 4 months in the intervention.The data provided insight into the self-perceived functioning, goals and action plans. Also, changes over time were observed. Self-perceived functioning changed from being mainly negative before, to mainly positive after the intervention. While goals were mostly related to the same ICF categories, the action plans changed from more specific short-term to more general long-term plans.Our study demonstrates that all categories of the ICF can be used to record self-perceived functioning, goals and action plans and monitor changes over time.The complete International Classification of Functioning, Disability, and Health (ICF) can provide a useful tool to record self-perceived functioning, goals, and action plans.Setting goals by using all ICF categories shows what is relevant to people themselves and can stimulate activities that foster functioning according to what people value.Assessments of self-perceived functioning, related goals, and action plans offer a novel approach to assessing health and comparing healthcare outcomes.The complete International Classification of Functioning, Disability, and Health (ICF) can provide a useful tool to record self-perceived functioning, goals, and action plans.Setting goals by using all ICF categories shows what is relevant to people themselves and can stimulate activities that foster functioning according to what people value.Assessments of self-perceived functioning, related goals, and action plans offer a novel approach to assessing health and comparing healthcare outcomes. [ABSTRACT FROM AUTHOR]

Purpose: When mobility deficits persist after stroke or spinal cord injury (SCI), outpatient neurorehabilitation services are required. This study aimed to explore the current practice of German outpatient neurorehabilitation services and identify factors associated to this practice. Methods: This was a qualitative observational study in which semi-structured interviews were conducted with professionals from outpatient neurorehabilitation services and mobility-impaired patients. A qualitative content analysis with a data-driven coding process was used. Results: Three general practitioners, five physical, five occupational, and one speech therapist, one neuropsychologist, two outpatient nurses, one rehabilitation technician, one social worker, two patient advocates (long-term survivors, each stroke and SCI), and 20 patients (10 after stroke, 10 after SCI, all first-ever affected since approximately one year) participated. The reported experiences ranged from high satisfaction to perceived deficits in participation-oriented, evidence-based, and coordinated care. Identified associated factors were: (a) availability of specialised therapists and professional education, (b) outpatient service catalogue, (c) cost coverage, (d) setting rehabilitation goals, and (e) physician as care coordinator. Conclusion: Areas of improvement identified focused on: setting rehabilitation goals towards participation, training therapists on evidence-based treatments and shared decision-making, updating the outpatient service catalogue, and implementing coordination actions. Implementation of these recommendations should be evaluated. IMPLICATIONS FOR REHABILITATION: Professionals need to be trained in setting rehabilitation goals and treatments. The continuing education should be based on current evidence and address interprofessionalism. Academization and continuing education in scientific work for therapists should be advanced. Professionals should educate patients about rehabilitation goals and set rehabilitation goals together, both interprofessional coordinated and with the patient (shared decision-making). Activity and participation should be the central aspects. Rehabilitation clinicians should give instructions to therapists on what to do if rehabilitation goals are not worked on. Rehabilitation clinicians should encourage interprofessional collaboration and information exchange where this is not the case. The exchange of information between outpatient professionals should be promoted through appropriate measures, that is, interprofessional meetings could be introduced. The outpatient service catalogue should be revised regarding evidence-based and participation-oriented treatments and enable appropriate cost coverage. [ABSTRACT FROM AUTHOR]

To investigate the usability and effectiveness of standardized circuit class group training (CCT) compared to individualized goal-directed group training (GDT) in subacute stroke survivors. This study consists of three parts. Part 1 involved a pragmatic, non-randomized controlled trial with subacute participants and their therapists, who participated in four weeks either CCT or GDT. Superiority of the intervention was defined as significantly larger improvement on the Motor Activity Log for patients and lower workload for therapists. In Part 2, six additional workstations were developed for CCT. Part 3 replicated the study of Part 1 with the expanded CCT. Part 1 showed no difference in effectiveness between training methods. CCT did not match the rehabilitation goals of the patient sufficiently, however mental workload seemed lower for therapists. An expansion of CCT could improve the match between the patient's goals and the training (Part 2). Results of Part 3 showed again no difference in effectiveness between methods. CCT was however perceived as less engaging compared to GDT, but mental load for therapists remained lower. A standardized training could reduce the mental workload for therapists, but patients seemed less engaged. A combination of both might be most beneficial.Trial registration: Dutch Trial Register: NL8844 and NL9471 Providing a standardized training program after stroke reduces therapists' mental workload. Individualized goal-directed group training results in the best achievement of rehabilitation goals. A combination of standardized and individual training would use best of both intervention modalities. Patients should be involved in the co-creation developing process of training programs. [ABSTRACT FROM AUTHOR]

To assess if a high-level mobility programme (HLMP) can promote sustained participation in physical activity by adolescents with cerebral palsy. Eight adolescents with cerebral palsy, Gross Motor Function Classification System levels I-II, 11–16 years, participated in 24 community-based group HLMP sessions across 12 weeks. Participants set attendance, involvement, and physical performance goals, completed activity diaries over 58 weeks and undertook physical capacity tests. Measures of activity frequency and diversity (attendance) and involvement level were collected weekly across baseline (4–6 weeks), intervention (12 weeks), and nine months follow-up (including Covid lockdown). Median attendance was 23 of 24 HLMP sessions. Attendance goal/s attainment was highest during COVID lockdown. Involvement goals were consistently attained throughout all phases. Physical performance goal/s attainment was highest during intervention phase but reduced during nine months follow-up. Frequency of participation in physical activities varied greatly across study phases (range 0–33 episodes/week) with stable variety of activities and generally high 'involvement.' During the intervention, seven participants improved physical capacity and six maintained, or increased, the gains six months later. Most participants improved physical capacity post-intervention but only some had sustained attendance and involvement in physical activity, highlighting the complexity of physical activity participation. Health professionals' promotion of sustained participation in physical activity needs to consider individual preferences for frequency, diversity and duration. Supporting and measuring involvement in physical activity should be prioritised as a key outcome of an intervention. Physical activity interventions should be followed up for longer than six months to determine sustained changes in participation outcomes Measuring physical capacity and performance gains alone is insufficient to determine sustained, meaningful participation. [ABSTRACT FROM AUTHOR]

Physiotherapists working in hospitals have a key role in decisions about when a person with stroke is safe to walk independently. The aim of this study was to explore the factors influencing decision-making of physiotherapists in this situation. A qualitative design with semi-structured interviews and reflexive thematic analysis was used. Fifteen physiotherapists with recent experience working in inpatient stroke rehabilitation participated. Multiple factors influence decision-making about walking independence after stroke in hospitals. Four themes were identified: (1) Assessment of walking safety involves observation of walking function and consideration of complex individual factors; (2) Perspectives on risk vary, and influence whether a person is considered safe to walk; (3) Institutional culture involves background pressures that may influence decision-making; and (4) Physiotherapists adopt a structured, individualised mobility progression to manage risk. Physiotherapists consistently use observation of walking and understanding of attention and perception in this decision-making. There can sometimes be a conflict between goals of independence and of risk avoidance, and decisions are made by personal judgements. Decision-making about independent walking for people in a hospital after a stroke is complex. Improved guidance about clinical assessment of capacity and determining acceptable risk may enable physiotherapists to engage more in shared decision-making. Regaining independence in walking after a stroke comes with the potential risk of falls. Assessment of walking safety should be specific to the complexity of the situation and consider perception and cognition. Benefits of activity and autonomy, and the risk of falls need to be considered in decisions about walking independence. Patients with the capacity to understand consequences and accept risk can be active participants in determining what is sufficiently safe. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResults\nIMPLICATIONS FOR REHABILITATIONTo explore the rehabilitation goals and evaluate goal attainment outcomes of people with severe acquired brain injury (ABI), and investigate the relationship between goal engagement and goal attainment.Mixed-methods cohort study with twenty-nine adults with severe ABI in Australia. Demographic data, goal statements and pre-post program Goal Attainment Scale scores as well as Goal Engagement Scale scores were collected. Goals were coded using inductive content analysis and categorised by ICF component and domain. Goal attainment within ICF categories was described and compared using descriptive statistics. Pre-post program change in goal attainment was evaluated using Wilcoxon signed rank tests and correlations between goal engagement and attainment was explored using Spearman’s (rho).94% of 320 goals were categorised as ICF Activity and Participation. There was significant improvement in goal attainment between admission and discharge (z=-0.47, p < 0.01). There was no significant relationship between goal engagement and goal attainment however there was a positive association between engagement in goal setting at admission and discharge.Conclusions: This interdisciplinary, inpatient rehabilitation program underpinned by key-worker facilitated person-centred, role-based goal setting resulted in goal attainment in chosen goals, which were primarily activity and participation-focused.Goal setting is a core rehabilitation practice and service delivery models that facilitate collaborative goal setting which engages patients, their significant others and health professionals as a team are necessary to enable person-centred care.Role-based goal setting effectively engaged patients with acquired brain injury and their families, facilitating goal setting and the formation of activity and participation-focused rehabilitation goals in this extended rehabilitation setting.Goal setting is a core rehabilitation practice and service delivery models that facilitate collaborative goal setting which engages patients, their significant others and health professionals as a team are necessary to enable person-centred care.Role-based goal setting effectively engaged patients with acquired brain injury and their families, facilitating goal setting and the formation of activity and participation-focused rehabilitation goals in this extended rehabilitation setting. [ABSTRACT FROM AUTHOR]

WHO recommends integrating rehabilitation into palliative care when providing services for people with life-threatening conditions. Recently, there has been increasing interest in exploring how rehabilitation and palliative care approaches could be combined. The aim of this study was to map and discuss the goals of intervention programmes that combine rehabilitation and palliative care. A scoping review was performed. The electronic databases MEDLINE, EMBASE, and CINAHL were searched for papers published between January 2014 and September 2022. Papers were considered eligible if the participants in question had a life-threatening disease and if interventions included both rehabilitation and palliative care. All study types were included. Ten papers describing five interventions were included. Qualitative goals were narratively described, and quantitative goals were analysed according to the International Classification of Functioning, Disability and Health, and the Total Pain framework. Findings showed an overall focus on functioning and quality of life. Further analysis indicated an emphasis on physical and psychological dimensions. Social participation, and the social and spiritual dimensions were rarely evaluated. This review indicates that goals relative to social participation, the social and spiritual dimensions, and the patient's own goals may well be overlooked as points of orientation for interventions. There is an increasing interest in combining palliative care and rehabilitation approaches in clinical work. When rehabilitation and palliative care are combined, goals may be overlooked, and the patient's own goals can be used as a point of orientation for interventions. Future practice should pay special attention to subjective goals, social participation, and the social and spiritual dimensions when combining rehabilitation and palliative care. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the process of implementing an evidence-based goal-setting package into five rehabilitation services across the continuum of rehabilitation. This study used a mixed methods approach guided by Medical Research Council (MRC) recommendations for conducting process evaluations, the RE-AIM framework, and the Theoretical Domains Framework (TDF). This study will evaluate the reach, adoption, implementation, and maintenance of the goal-setting package over six months. Environmental context and resources, the clinician's social and professional role and identity, social influences and clinician beliefs about goal-setting consequences and individuals' capabilities were all identified as barriers or enablers throughout the implementation process. Community rehabilitation services faced challenges implementing paper-based resources, whilst inpatient rehabilitation sites faced challenges engaging nursing staff in the interdisciplinary approach to goal-setting. Social influences were an enabler in two sites that used the case conference format to facilitate setting common goals. Clinicians in all sites continued to express difficulties implementing shared decision-making with people who had cognitive impairments or were no longer progressing in their rehabilitation. A team-based approach to implementing the goal-setting interventions centred around the case conference format appeared to be the most successful mode for implementing interdisciplinary person-centred goal-setting. The rehabilitation case conference forum can be used to facilitate teams to set interdisciplinary common goals. Rehabilitation teams should add further consideration to how they can involve clients as a member of the rehabilitation team throughout the rehabilitation process. Embedding changes into existing process and using structured templates and tools can enhance the process of goal-setting in rehabilitation. Strong leadership, dedicated facilitation, audit and feedback can enhance team's success in implementing elements of the goal-setting implementation package. [ABSTRACT FROM AUTHOR]

Specialised vocational rehabilitation (VR) following acquired brain injury (ABI) positively impacts return to work, however access to this is limited globally. Providing VR as a component of standard ABI rehabilitation may improve access to VR and influence vocational outcomes. This study aimed to develop an evidence-based framework for the delivery of ABI VR during early transitional community rehabilitation. The development of the ABI VR framework utilised an emergent multi-phase design and was informed by models of evidence-based practice, national rehabilitation standards, guidelines for complex intervention development, model of care and framework development, and the knowledge-to-action framework. Four study phases were undertaken to identify and generate the evidence base, with findings synthesised to develop the ABI VR framework in phase five. The framework provides a structure for the systematic delivery of VR as a component of team-based ABI rehabilitation, through five phases of rehabilitation: assessment; goal setting and rehabilitation planning; intervention; monitoring and evaluation; and discharge. It details the activities to be undertaken across the phases using a hybrid model of ABI VR (involving program-based VR and case coordination) and contains service delivery features. The framework has the potential to translate to other similar service contexts. An evidence-based framework has been developed to support the provision of vocational rehabilitation as a component of team-based rehabilitation for adults with acquired brain injury, within the context of early, community rehabilitation. Providing vocational rehabilitation as a component of team-based rehabilitation should improve access to vocational rehabilitation and may positively influence client return to work outcomes. The vocational framework may assist clinicians to identify components of vocational rehabilitation that they can deliver in practice in their own service context. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo understand the expectations and demand for a movement-tracking videogame (Bootle Blast) for home-based, upper limb (UL) rehabilitation among Costa Rican children with cerebral palsy (CP).Data were collected via telephone screening (demand) and child-parent dyads Zoom interviews (expectations). Descriptive statistics and data transformation were used to report on demand success criteria (i.e., recruitment rate, having an appropriate screen and space to play, setting a weekly play time goal (PTG) ≥45 min, identifying one UL therapy goal). The DEPICT model for collaborative qualitative analysis was used in the thematic analysis of interview data.Fifteen dyads participated (1.6 ± 1 recruited/month). All had a flat-screen TV in a suitable location to play, were able to set a UL therapy goal, and established PTGs ranging from 45–120 min per week. Identified themes were: 1) Socio-cultural factors heighten demand, 2) Feelings of hope prevail for the intervention, and 3) Collaborative goal setting supports realistic expectations for Bootle Blast.Dyads had positive and realistic expectations about implementing the proposed videogaming intervention. This study provides insights on tailoring a family-centered, therapy gaming intervention to improve access to motor rehabilitation for children with CP in rural/remote settings and low-middle income countries.Costa Rican children have limited access to upper limb rehabilitation due to a combination of economic barriers, societal factors and the family context.Costa Rican children with cerebral palsy and their families expected home-based therapy gaming to be adaptable to their routines and aligned with their interests.Families perceived therapy gaming interventions as a promising path to access, participation, and enjoyment of at home upper limb motor therapy.Costa Rican children have limited access to upper limb rehabilitation due to a combination of economic barriers, societal factors and the family context.Costa Rican children with cerebral palsy and their families expected home-based therapy gaming to be adaptable to their routines and aligned with their interests.Families perceived therapy gaming interventions as a promising path to access, participation, and enjoyment of at home upper limb motor therapy. [ABSTRACT FROM AUTHOR]

To critically explore experiences following thumb amputation and delineate elements of an ideal thumb prosthesis from the end user perspective. A qualitative study was undertaken with end user stakeholder groups, which included persons with a thumb amputation, rehabilitation professionals, and prosthetists. Analysis proceeded in line with conventional content analysis. Six patients with traumatic thumb amputation and eight healthcare providers (HCPs) were interviewed. Six themes were identified. The first theme discussed the impact of losing a thumb upon function, occupational activities, and mental wellbeing. The second theme reflected the idiosyncratic nature of thumb amputees, including their goals and nature of injury. The third theme stressed the costs associated with obtaining a thumb prosthesis. The fourth theme explored patient frustration and causes of device abandonment. Theme five summarized opinions on currently available thumb prostheses, and theme seven was the ideal design for a thumb prosthetic, including sensory elements and materials. Representative data from stakeholders mapped the current status of thumb prostheses. Preferences for an ideal thumb prosthesis included a simple, durable design with the ability to oppose, grasp, and sense pressure. Affordable cost and ease of fit emerged as systemic objectives. Provides insight into the experiences of individuals following thumb amputation. Identifies challenges that may lead to prosthetic abandonment so that these can be considered and addressed by rehabilitation professionals. Identifies positive elements and preferred materials in current prosthetics so that rehabilitation professionals may incorporate these more frequently. [ABSTRACT FROM AUTHOR]

This Perspectives paper advances understanding of coaching in pediatric rehabilitation. We compare three coaching approaches designed for pediatric rehabilitation: Coping with and Caring for Infants with Special Needs (COPCA), Occupational Performance Coaching (OPC), and Solution-Focused Coaching in Pediatric Rehabilitation (SFC-peds). Our objectives are to contrast the theory underpinning the approaches, discuss the evidence for outcomes and hypothesized mechanisms of change, consider the necessary mindsets of effective coaches, and propose directions for research and practice. The coaching approaches have different theoretical bases and are designed for specific contexts, yet are similar in their mechanisms of change and intended outcomes. There is growing evidence of important effects of coaching on coachees' goal achievement, empowerment, and capacity building. Studies indicate that stakeholders value coaching, and provide a preliminary understanding of the mechanisms, including engagement and self-efficacy, by which coaching approaches support clients' self-directed and sustained change. Open, curious, and client-centered practitioner mindsets are fundamental to effective coaching. Coaching is a distinctive group of relational, goal-oriented, and evidence-based approaches that support goal achievement and empowerment. These approaches reflect and advance an ongoing paradigm shift in pediatric rehabilitation—a movement from therapist-as-expert approaches to those that build empowerment and capacity. Coaching is a distinctive group of theory-based approaches that support clients' goal achievement and empowerment, and build capacity Coaching practitioners are collaborative facilitators who assist clients and families with their own discovery of solutions that fit their everyday contexts The evidence suggests that coaching triggers engagement and self-efficacy, which are the mechanisms by which changes in longer-term outcomes occur Open, curious, and client/family-centered practitioner mindsets are fundamental to effective coaching [ABSTRACT FROM AUTHOR]

Because people living with environmental sensitivities are poorly acknowledged in our society, we still know very little about their experiences navigating in the health care system, especially with respect to dental services. Our objective, therefore, was to describe their dental care pathway and better understand their experiences accessing oral health services. A qualitative descriptive study was conducted in partnership with organizations supporting people with environmental sensitivities. Through a criterion sampling technique, 12 people living with environmental sensitivities in Quebec (Canada) were invited to participate in individual semi-structured interviews. These interviews lasted around 90 min and were transcribed to be thematically analysed. Participants faced major barriers accessing dental services and thus lived for long periods of time with unmet dental needs. Their dental care pathways were often delayed or even interrupted for several reasons. First because they were exposed to pollutants upon leaving their house, which rendered their trip to the dentist perilous. Second because dentists lacked knowledge about environmental sensitivities and seemed reluctant to accommodate them. We invite governments, dental professionals, and researchers to develop policies and clinical approaches for improving people living with environmental sensitivities' quality of life and access to dental services. Although environmental sensitivities are recognized as disability in several countries such as Sweden and Germany, people with these conditions face major barriers to access healthcare services. Dental professionals, for instance, are reluctant to acknowledge environmental sensitivities as a disability and seldom accommodate sufferers' special needs. We invite dentists to foster holistic and person-centered approaches and be receptive to the health conditions and needs of people with environmental sensitivities. Dentists could address oral health needs of people with environmental sensitivities by doing home-visits with portable dental equipment as this removes barriers related to their exposure to pollutants. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) affects one in 66 children in Canada, and its symptoms may be particularly challenging for parents from a Chinese background. Further, when working with Chinese families, Western-educated service providers may experience difficulty in applying culturally relevant and family-centered care. This study examined the experiences of one Chinese-Canadian family as they receive intervention services for their two children with ASD. This pilot, single-case design, qualitative case study included semi-structured interviews with the parents, grandparents, as well as three service providers' views. Three major themes emerged from the data in the form of tensions: (1) within the family members; (2) within the therapeutic relationships, and (3) in addressing culture in therapy. Results suggested that although the family identified key cultural differences, service providers did not sufficiently address these within the therapeutic relationship, and the need for culturally-relevant and family-centered care was not fulfilled. Chinese-Canadian parents for children with autism spectrum disorder adopt both Chinese and Western values that fit best for their circumstances. Service providers and family members can have conflicting priorities, making family-centered care, culturally-relevant care challenging. Culture plays an important role in family expectations, and should be incorporated with more intention in the rehabilitation process. [ABSTRACT FROM AUTHOR]

This study aims to investigate whether the treatment effects, in terms of goal attainment, transfer effects and impact on executive functions, of an intervention in children with cerebral palsy or spina bifida using the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach are maintained over time, from immediately after the intervention to three months afterwards. A three-month follow-up study, from an intervention using CO-OP. Thirty-four children (7–16 years) each identified four goals (one untrained to examine transfer) and participated in an eleven-session intervention. Assessments were performed at baseline, immediately after the intervention and at a three-month follow-up using the Canadian Occupational Performance Measure and the Performance Quality Rating Scale. Executive function and self-rated competence were assessed at the same timepoints. Statistically significant and clinically relevant improvements in goal achievement were demonstrated for both trained and untrained goals after the intervention and were maintained at follow-up. The clinically relevant improvement in untrained goals continued to increase until follow-up. Self-rated competence increased after the intervention and was maintained at follow-up. The CO-OP intervention was effective in achieving and maintaining the children's own goals over time. The transfer effect was confirmed by higher goal attainment for the untrained goals. The children's self-defined goals were achieved after the Cognitive Orientation to daily Occupational Performance (CO-OP) intervention and remained so at the three-month follow-up. The CO-OP Approach is useful for children with cerebral palsy or spina bifida. A transfer effect was demonstrated for untrained goals by both subjective and objective assessments. Using children's self-defined goals is effective. [ABSTRACT FROM AUTHOR]

To determine whether Residential Immersive Life Skills programs (RILS) result in reliable change in autonomy and self-efficacy of youth with disabilities and whether gains persist over time. Sex differences and program response patterns were also examined. Autonomy from the ARC's Self-Determination Scale and self-efficacy from the General Self-Efficacy Scale were completed by participants at baseline, post-intervention, 3-month, and at 12-month follow-ups. Reliable change index was calculated and examined over time. Autonomy improved significantly following the completion of RILS program and gains persisted and increased at 12-month follow-up. Participants who reliably improved in autonomy (program-responders) also improved in self-efficacy. The program-responders began the program with significantly lower autonomy and self-efficacy scores at baseline and differed in personal factor relative to those who did not experience increased autonomy post-program (non-responders). There were sex differences in program response with more male participants responding to the program. RILS programs can result in sustained improvements in autonomy and self-efficacy. Urgency for change and personal needs/priorities may contribute to growth experiences. We recommend including a social connectedness module that formally facilitates friendships and social development to better meet the social needs of all youth, especially females with disabilities. Youth's autonomy improves following participation in Residential Immersive Life Skills programs. Over time, improvements in youth autonomy may lead to improvements in self-efficacy. It is important to measure gains over time as beneficial change increase over time. More male participants may experience outcome change in autonomy than female participants. Urgency for change and personal needs/priorities may contribute to growth experiences. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of environment-based intervention on participation outcomes and parent efficacy in autistic children. Twenty-one autistic children 6–10 years old and their parents were randomized to environment-based intervention (n = 11) or usual care (n = 10). The environment-based intervention targets individualized participation goals in leisure and community activities through changing environment and activity demands. The study outcomes were Canadian Occupational Performance Measure (COPM), Goal attainment scaling (GAS), and Parent Empowerment and Efficacy Measure (PEEM). Assessments included baseline, 12 weeks (post-test), and 24 weeks (follow-up). Mixed ANOVAs were used to examine within-group and between-group effects in outcome variables. The COPM performance and satisfaction scores and GAS T-scores increased after environment-based intervention from baseline to 12 weeks and 24 weeks (p < 0.001) but did not significantly differ from usual care. The medium to large effect sizes of COPM performance and GAS T-scores favored the environment-based intervention. For the PEEM scores, no significant differences were found. Environment-based intervention may support school-age autistic children to participate in self-chosen activities over time. The intervention effects on participation goals and parent efficacy, however, were inconclusive and need further research. Environmental barriers are important attributes to participation restriction in autistic children. Interventions focusing on modifying the task and environment is viable in supporting the participation of autistic children. The environment-based intervention appears to improve the participation goals in leisure and community-based activities over time. The environment-focused strategies may include providing social support, enabling access to a sensory-friendly environment, finding inclusive programs, adapting task demands, and managing routines. [ABSTRACT FROM AUTHOR]

To investigate how a quality improvement program (BRIDGE), designed to promote coordination and continuity in rehabilitation services, was delivered and perceived by providers in routine practice for patients with rheumatic and musculoskeletal diseases. A convergent mixed methods approach was nested within a stepped-wedge, randomized controlled trial. The intervention program was developed to bridge gaps between secondary and primary healthcare, comprising the following elements: motivational interviewing; patient-specific goal setting; written rehabilitation-plans; personalized feedback on progress; and tailored follow-up. Data from health professionals who delivered the program were collected and analyzed separately, using two questionnaires and three focus groups. Results were integrated during the overall interpretation and discussion. The program delivery depended on the providers' skills and competence, as well as on contextual factors in their teams and institutions. Suggested possibilities for improvements included follow-up with sufficient support from next of kin and external services, and the practicing of action and coping plans, standardized outcome measures, and feedback on progress. Leaders and clinicians should discuss efforts to ensure confident and qualified rehabilitation delivery at the levels of individual providers, teams, and institutions, and pay equal attention to each component in the process from admission to follow-up. Quality in rehabilitation should be characterized by a continuous and coordinated process from goal setting to follow-up. To improve the quality, sufficient involvement of next of kin and external services is needed. Clinicians may need training to build confidence in motivational interviewing, action- and coping planning, feedback on progress, and follow-up. Leaders should organize education sessions, optimize schedules, insert standardized outcome measures, and facilitate collaboration across levels of care and services. [ABSTRACT FROM AUTHOR]

Strategy training is a rehabilitation intervention that aims to enhance problem-solving skills with respect to daily activity–related challenges and has achieved favorable results in Western countries. This study explored the perspectives of individuals with acquired brain injury (ABI) in Taiwan who received strategy training. Semi-structured interviews with community-dwelling adults with ABI were conducted, and reflective memos made by research team members were recorded. Interviews and memos were analyzed through thematic analysis This study included 55 participants. The analysis of the participants' interview responses and memos yielded nine themes under three categories: 1) expectations regarding strategy training, 2) perceived benefits of strategy training, and 3) barriers affecting the process and outcomes of strategy training. All the participants endorsed strategy training through different gains. Most participants' expectations before the intervention were uncertain. Including family members into the strategy training is of key importance for a successfulness of their goals. The participants' experiences about strategy training were affected by various barriers (i.e., health and medical problems, the physical environment, and natural events). Clinicians and researchers should consider these expectations, benefits, and barriers when studying and implementing strategy training in non-Western contexts. Strategy training provides clients the opportunity to actively engage in their own goal setting and decision making. Strategy training increases the client's confidence in their ability to participate in the community, communicate, and perform daily living and physical activities. Therapists should consider the health conditions and physical environment of clients when helping them set goals and before facilitating their engagement in the community. Taiwanese family members play a crucial role in supporting acquired brain injury survivors in strategy training. [ABSTRACT FROM AUTHOR]

To develop a checklist to facilitate coordination of care and communication of patients with brain tumors and assess the benefit of the checklist using a quality improvement survey Rehabilitation teams are challenged to respond to the unique needs of patients with brain tumors as this population requires coordinated care across multiple disciplines with frequent communication. To improve care of this patient population in an IRF setting, we developed a novel checklist using a multidisciplinary team of clinicians. Our checklist aims to improve communication between multiple treatment teams, achieve appropriate goals during the IRF stay, involve services as needed and arrange post-discharge services for patients with brain tumors. We then used a quality improvement survey among clinicians to assess the efficacy and general opinion of the checklist. A total of 15 clinicians completed the survey. 66.7% felt that the checklist improved care delivery, and 66.7% felt the checklist improved communication between providers internally and with external institutions. More than half felt the checklist improved the patient experience and care delivery. A care coordination checklist has the potential to address the unique challenges experienced by patients with brain tumors to improve overall care for this population. Successful clinical care and rehabilitation of patients with brain tumors requires the coordinated efforts of an interdisciplinary team that often spans multiple care settings. A care coordination checklist has the potential to address the unique challenges experienced by patients with brain tumors to improve overall care for this population in the inpatient rehabilitation setting. [ABSTRACT FROM AUTHOR]

To ascertain the feasibility and acceptability of delivering a job retention vocational rehabilitation intervention [MSVR] for people with multiple sclerosis (pwMS) in a community setting. Secondary objectives included determining whether MSVR was associated with changes in quality of life, fatigue, mood, cognition, workplace accommodations, work instability, work self-efficacy, and goal attainment. Single-centre mixed-methods feasibility case series. 15 pwMS and three employers received 8.36 (SD = 4.48) and 1.94 (SD = 0.38) hours of MSVR respectively over three months. The intervention predominantly addressed managing cognition, fatigue, and negotiating reasonable accommodations. Four healthcare professionals were recruited to clarify clinical information. The intervention was feasible to deliver, and there was a significant positive impact on goal attainment immediately following MSVR (t(14) = 7.44, p =.0001, d = 1.9), and at months 3 (t(13) = 4.81, p =.0001, d = 1.28), 6 (t(11) = 4.45, p =.001, d = 1.28), and 12 (t(9) = 5.15, p =.001, d = −2.56). There was no impact on quality of life, fatigue, mood, cognition, workplace accommodations, work instability, and work self-efficacy. In post-intervention interviews, participants reported that MSVR was acceptable. Four themes were derived regarding the context, employer engagement, empowerment through knowledge, and intervention components and attributes. It was feasible and acceptable to deliver MSVR. Participants better understood their MS, became more confident managing problems at work and attained their work-related goals. People with multiple sclerosis (MS) experience problems at work because of the interaction between symptoms and environmental factors (e.g., co-workers' attitudes). Vocational rehabilitation for people with MS and their employers should be tailored in terms of content and intensity. People with MS can be empowered at work by learning about MS and how their symptoms fluctuate over time. Understanding legal responsibilities and examples of accommodations at work can be beneficial for employers. [ABSTRACT FROM AUTHOR]

To develop an online self-management program for individuals with recent lower limb loss, called Self-Management for Amputee Rehabilitation using Technology (SMART). We used the Intervention Mapping Framework as a blueprint and involved stakeholders throughout the process. A six-step study was conducted including (1) needs assessment using interviews, (2) translating needs to content, (3) applying the content into a prototype using theory-based methods, (4) a usability assessment using think-aloud cognitive testing, (5) planning for future adoption and implementation, and (6) assessing feasibility using mixed-methods to generate a plan to assess the effectiveness on health-outcomes in a randomized controlled trial. Following interviews with healthcare professionals (n = 31) and people with lower limb loss (n = 26), we determined the content of a prototype version. We then tested usability (n = 9) and feasibility (n = 12) by recruiting individuals with lower limb loss from different pools. We modified SMART to be assessed in a randomized controlled trial. SMART is a six-week online program with weekly contact of a peer mentor with lower limb loss who supported patients with goal-setting and action-planning. Intervention mapping facilitated the systematic development of SMART. SMART may improve health outcomes, but this would need to be confirmed in future studies. Learning new coping strategies and habits are essential after lower limb loss. Given the limitations and inaccessibility of educational and rehabilitation programs, online self-management education can assist patients in their recovery. Self-Management for Amputee Rehabilitation using Technology (SMART) has the potential to augment the self-management behaviors in individuals with lower limb loss through an improvement in access to educational content, skill-based videos, and support of a peer. [ABSTRACT FROM AUTHOR]

Acquired brain injury (ABI) is a leading cause of lifelong disability, but access to treatment in the chronic stages has significant barriers. Group-based, remotely delivered neurorehabilitation reduces costs, travel barriers, and infection risk; however, its feasibility for patients with ABI is not well-established. To investigate the feasibility of remotely group-based cognitive and mood therapies for persons with chronic ABI. Three hundred and eighty-eight adults with chronic ABI participated in group tele-neurorehabilitation modules comprising Cognitive Behavioral Therapy, Goal Management Training®, Relaxation and Mindfulness Skills Training, and/or a novel Concussion Education & Symptom Management program. Assessments comprised quantitative metrics, surveys, as well as qualitative semi-structured interviews in a subset of participants. High retention, adherence, and satisfaction were observed. Facilitators of treatment included accessibility, cost-effectiveness, and convenience. Adoption of technology was high, but other people's technological interruptions were a barrier. Self-reported benefits specific to group-based format included improved mood, stress management, coping, interpersonal relationships, cognitive functioning, and present-mindedness. The present study examined chronic ABI patients' perceptions of telerehabilitation. Patients found remotely delivered, group-based mood, and cognitive interventions feasible with easy technology adoption. Group format was considered a benefit. Recommendations are provided to inform design of remotely delivered ABI programs. Group-based mood and cognitive telerehabilitation is feasible for persons with chronic acquired brain injury, with high reported satisfaction. Screening for technical proficiency and providing ongoing technical support improves therapy adherence and retention. Integration of clinical care and research is feasible for delivering remote therapies to persons with brain injury. [ABSTRACT FROM AUTHOR]

To identify the contexts in which goal setting has been used in chronic disease management interventions and to estimate the magnitude of its effect on improvement of health outcomes. The strength of evidence and extent of potential bias in the published systematic reviews of goal setting interventions in chronic conditions were summarized using AMSTAR2 quality appraisal tool, number of participants, 95% prediction intervals, and between-study heterogeneity. Components of goal setting interventions were also extracted. Nine publications and 35 meta-analysis models were identified, investigating 25 health outcomes. Of the 35 meta-analyses, none found strong evidence and three provided some suggestive evidence on symptom reduction and perceived well-being. There was weak evidence for effects on eight health outcomes (HbA1c, self-efficacy, depression, anxiety, distress, medication adherence, health-related quality of life and physical activity), with the rest classified as non-significant. Half of the meta-analyses had high level of heterogeneity. Goal setting by itself affects outcomes of chronic diseases only to a small degree. This is not unexpected finding as changing outcomes in chronic diseases requires a complex and individualized approach. Implementing goal setting in a standardized way in the management of chronic conditions would seem to be a way forward. The link between goal setting and health outcomes seems to be weak. Some levels of positive behavioural change could be of benefits to patients as seen by improved self-efficacy, patients' satisfaction and overall quality of life. Systematic and consistent application of personalized goal-oriented interventions considering patient's readiness to change could better predict improved outcomes. Incorporation of various goal setting components while actively engaging patient and/or their care givers in the process could appraise how goal setting could help with challenges in faced by people living with chronic conditions in different areas. [ABSTRACT FROM AUTHOR]

To examine patients' perception of performance and satisfaction with the activities in their set goals before and after very early supported discharge (VESD) with continued rehabilitation. A descriptive cohort study with data extracted from a randomized controlled trial. Sixty-nine patient allocated to the intervention group were eligible. Before discharge, the patients were asked to set rehabilitation goals, and they were asked to rate the performance and satisfaction of their set goals. At discharge from the rehabilitation, the patients were asked to re-evaluate their experience and satisfaction with the goal performance. One hundred and forty goals were registered. At 81.5% of the set goals, the patients estimated that they performed the task better at discharge than at enrolment and at 86.5% of the set goals the patients were more satisfied with the performance at discharge than at enrolment. Patients with mild to moderate stroke, undergoing a VESD after stroke, reported high performance level for their set goals and were satisfied with their performance execution. Further research is needed to investigate whether the goal should be set preferably at home or at hospital before discharge. Many of the patients can formulate achievable goals with their rehabilitation after stroke. Patients ongoing rehabilitation after stroke are satisfied with their performance of the set goals. As part of patient-centered care, stroke patients should be given the opportunity to formulate their own goals with their rehabilitation. Short hospital times and fast planning of goal-meetings, seems to influence patient goal setting in early discharge rehabilitation. [ABSTRACT FROM AUTHOR]

Persons with lower limb loss (PwLLL) must self-manage their residual limb and their prosthesis to prevent self-management related complications (SMRC). However, the experience of PwLLL as it relates to self-management has not been reported. Thus, the purpose of this study was to explore the experience of self-management from the perspective of PwLLL, prosthetists, and physical therapists. This study had a qualitative design. Twenty-three participants were interviewed (PwLLL = 10, prosthetists = 7, physical therapists = 6). Interviews were transcribed and then coded using constant comparison. Four prominent themes were developed from the transcripts: (1) embodying the duty of self-management, (2) being a vigilant self-advocate, (3) setting goals collaboratively, and (4) making informed decisions. Each of the four themes were influenced by the health beliefs of the PwLLL, specifically motivation and presence of an internal locus of control. Clinicians should emphasize the therapeutic relationship, including open communication, collaborative goal setting, and promoting an internal locus of control in interactions with PwLLL, as it may play a role in decreasing SMRC and improving clinical outcomes. Self-management is a crucial aspect of preventing secondary complications associated with limb loss and prosthesis use. Self-management requires an internal locus of control, problem-solving abilities, and foundational knowledge Clinicians can promote self-management through collaborative goal setting and systematic education. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a complex health condition requiring long-term rehabilitation. Person-centred goal-setting is a central component of rehabilitation. However, knowledge of patients' perspectives on the goal-setting in SCI rehabilitation is scarce. The purpose was therefore to explore patients' perspectives on goal-setting in multidisciplinary SCI rehabilitation. An anthropological study combining participant-observation and individual interviews. Data were analysed using reflexive thematic analysis. The COREQ checklist was used to report study quality. Patients with SCI perceived goal-setting as ambiguous. On the one hand, they considered it insignificant, because it was complicated to transform complex needs of everyday life to recommended criteria of goals being measurable, specific, and realistic. On the other hand, they considered it a potentially useful guiding tool. Patients were uncertain of impact of goals and perceived goal-setting as vague during rehabilitation. Patient involvement was challenged by insufficient integration of patients' experience-based knowledge of everyday life and clinicians' profession-based knowledge. Goal-setting in rehabilitation is not the patients' need but they accept it as the clinicians' framework for rehabilitation. For goal-setting to become meaningful to patients with SCI, patient involvement should be strengthened by equally integrating the patients' perspectives in the goal-setting process. Health-care professionals have to strengthen patient involvement in SCI rehabilitation by to a greater extent integrating the patients' knowledge of their everyday life and preferences rather than primarily focusing on profession-based knowledge. Health-care professionals must support patients in setting goals which are practically meaningful and relevant to the patients' everyday life and achievably and if needed go beyond the structured measurement of SMART goals. In an acknowledgement of the dynamic nature of goal-setting, clinicians should emphasise formulating goals in a flexible and non-directive manner, thereby providing room for patients' changing needs and challenges over time. Goals in SCI rehabilitation cover a wide range from broad, value-based goals to more specific goals, and the health-care professionals must ensure inclusion of such a wide range of goals. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

This commentary examines the provisions for early childhood development (ECD) in the global action plan for rehabilitation published by the World Health Organisation (WHO) within the context of the United Nations' Sustainable Development Goal (SDG) for inclusive education. The meeting reports of the WHO Rehabilitation 2030 for 2017 and 2019 and the related documents were reviewed along with ECD policy documents from WHO, UNICEF, UNESCO, and the World Bank. The importance of a life-course approach to rehabilitation for the health and wellbeing of persons with disabilities was highlighted in the Rehabilitation 2030. However, the critical and foundational role of rehabilitation in ECD for children with disabilities to facilitate inclusive education, especially in low- and middle-income countries as envisioned by the SDG 4.2, was not clearly addressed. Children under 5 years with developmental delays and disabilities who are not developmentally on track in health and psychosocial wellbeing require timely rehabilitation to ensure that they benefit from inclusive education. The culture and practice of rehabilitation should be nurtured from infancy as an indispensable component of ECD to adequately prepare children with developmental disabilities for inclusive education and ensure effective rehabilitation services over the life course. Rehabilitation is an integral and critical component of early childhood development to optimise school readiness for children with developmental disabilities. Routine newborn screening, developmental assessment, and surveillance of children from birth are foundational to any effective rehabilitation in early childhood. Global investment to promote and support rehabilitation services from early childhood within the health systems and across all levels of service delivery including community settings is warranted to achieve the sustainable development goals for children with disabilities. [ABSTRACT FROM AUTHOR]

Music therapy (MT) has been used in health care settings for a wide variety of treatment goals. Many inpatients with neurologic impairments struggle with low mood and pain for which MT may be a novel adjunct treatment. The aims of this study were to: (1) evaluate change in mood and pain following a single MT session; (2) explore the impact of an MT program on mood, pain and satisfaction from the perspective of the patient, family and staff. A mixed-methods study was conducted. Forty participants completed pre/post MT surveys evaluating mood, pain and satisfaction. Individual semi-structured interviews and focus groups were conducted with 14 MT program participants (inpatients), 5 family members of participants and 16 staff. There was significant improvement in mood (p < 0.001) and decrease in pain (p < 0.05) from pre-to-post MT with 74% reporting being "very satisfied" with the session. "Benefits of MT" was the overarching theme of the qualitative data. Subthemes were emotional regulation, pain management, effects on self-concept, enjoyment, and social connectedness. Improvements in mood and pain were reported from pre-to-post MT session and in interviews. Further evaluation of MT effectiveness against standard of care rehabilitation and cost implications is required. Music therapy (MT) is delivered by accredited music therapists (MTAs) in health care settings, including rehabilitation units, as an individual, group or co-treatment therapy. MT can be used for a range of health outcomes, including the treatment of mood and pain, in addition to improving inpatient satisfaction. Early evidence using pre/post MT surveys suggests an improvement in mood and pain following a single therapy session. Qualitative data suggest overall benefit of offering MT services in addition to standard neurorehabilitation therapy, including improvements to emotional regulation, pain management, self-concept, enjoyment, and social connectedness. [ABSTRACT FROM AUTHOR]

Goal setting is key to stroke rehabilitation, but access for people with aphasia is challenging. Based on the Goal setting and Action Planning (G-AP) framework, we developed an accessible goal setting resource (Access G-AP). Access G-AP was designed using a three-phase, user-centred design process. Phase 1: Access G-AP Draft A was designed using evidence-based recommendations. Phase 2: Draft A was reviewed by stroke survivors with aphasia (focus groups 1&2) and rehabilitation staff (questionnaire). Phase 3: Suggested recommendations informed Access G-AP Draft B, which was further reviewed by stroke survivors with aphasia (focus group 3). The final version of Access G-AP was approved by stroke survivors with aphasia at a debrief meeting. Data were analysed using content analysis. Recommended design improvements included reducing text, adding bullet points, and diversifying images. Both participant groups highlighted that Access G-AP should be used collaboratively to support stroke survivor involvement. Staff recommended Access G-AP training and additional resources to support stroke survivors with severe aphasia. Access G-AP was co-developed to support people with aphasia to access and engage in stroke rehabilitation goal setting. Further research is required to establish the feasibility of Access G-AP in clinical practice. Evidence-based accessible formatting strategies and an iterative design process can inform the design of accessible goal setting resources. Accessible goal setting materials should be relevant to stroke survivors with aphasia and responsive to their needs. Rehabilitation staff require training and support to use accessible goal setting resources (like Access G-AP) with stroke survivors with aphasia, especially those with severe aphasia. Evaluation of the feasibility of Access G-AP in clinical practice is now required. [ABSTRACT FROM AUTHOR]

Patient values, preferences, and circumstances are critical to decision-making in both patient-centred and evidence-based practice models of healthcare. Despite the established importance of integrating these patient attributes, the ways they are elicited in rehabilitation remain unclear. This study aimed to explore how health professionals elicit and share patients' 'values', 'preferences', and 'circumstances', and what they understand by the terms. This exploratory qualitative descriptive study used interviews with 13 clinicians from interprofessional teams in inpatient neurological rehabilitation. Data were analysed using a general inductive approach. Participants understood 'values' to mean what is important and meaningful; 'preferences' as likes/dislikes and choices; and 'circumstances' as the social, physical, and environmental context surrounding the person. Formal and informal strategies were used to gather information directly from patients or indirectly from other sources. The processes of eliciting and communicating this information were influenced by relationships and relied on contributions from many people. Elicitation involved a flexible approach tailored to the individual and considering each unique context. The strategies used and the approach used to implement these strategies were both essential to eliciting patient values, preferences, and circumstances in neurological rehabilitation. These findings offer insights into the practices of interprofessional rehabilitation clinicians. Eliciting patient values, preferences, and circumstances involves a combination of strategies and approaches that are applied gradually throughout the continuum of rehabilitation. These processes are flexible, and strategies should be tailored to individual patients/families and phases of rehabilitation. Clinicians should be attentive to informal opportunities to gather valuable information throughout rehabilitation. Establishing positive relationships and using effective communication is foundational to these processes. [ABSTRACT FROM AUTHOR]

To examine the effects of ride-on car (ROC) training using different postures on mobility and social function in children with motor delays in comparison with conventional therapy. Thirty-eight children (22 males, 16 females) with motor delays were recruited and randomly assigned to three groups: ROC training while sitting (ROC-Sit, n = 15; mean age, 20.25 months; standard deviation [SD], 5.29), ROC training while standing (ROC-Stand, n = 12; mean age, 24.80 months; SD, 8.42), and conventional therapy (control, n = 11; mean age: 20.25 months, SD: 5.37). All groups underwent 2-h training sessions twice weekly over a 12-week intervention phase. The Pediatric Evaluation of Disability Inventory and Goal Attainment Scaling were performed before and after the intervention and at follow-up sessions after 12 weeks. Mobility and goal achievement improved significantly in all groups after the intervention (p < 0.001; p < 0.0001). However, social function improved significantly only in the ROC-Stand group (p = 0.001), which had the highest number of participants showing clinically meaningful changes in mobility and social function. Increased practice and caregivers' involvement can improve children's mobility and goal achievement. Adopting a standing posture in an ROC can enhance social function. Providing active exploratory experience through ride-on cars or practicing specific skills can improve children's mobility function. Ride-on car training in a standing posture allows children to access their distal environment visually, resulting in improved social function. Setting goals with caregivers maximizes the effects of treatment on goal achievement. [ABSTRACT FROM AUTHOR]

To assess attainment of individual treatment goals one year after intrathecal baclofen (ITB) pump implantation in individuals with dyskinetic cerebral palsy (CP). A multi-center prospective cohort study was conducted including 34 non-walking individuals with severe dyskinetic CP, classified as Gross Motor Function Classification System (GMFCS) IV/V, aged 4–24 years, 12 months after pump implantation. The main outcome measure was Goal Attainment Scaling (GAS). Predictors of GAS results were analyzed. Complications were registered systematically. Seventy-one percent of individuals with dyskinetic CP fully achieved one or more treatment goals. One or more treatment goals were partially achieved in 97% of individuals. Two factors were found to be associated with attainment of goals: Dyskinesia Impairment Scale (DIS) score at baseline and the difference in pain score between baseline and follow-up. These two variables explain 30% of the variance in the outcome. Intrathecal baclofen is effective in achieving individual treatment goals in children and young adults with dyskinetic CP after nine to 12 months of ITB treatment. A positive outcome on treatment goals is, for a small part, associated with higher severity of dystonia at baseline and with improvement of pain during treatment. Dutch Trial Register, number NTR3642. Intrathecal baclofen treatment is effective in attainment of personal treatment goals, one year after pump implantation in patients with dyskinetic cerebral palsy. A positive outcome on treatment goals is, for a small part, related to higher severity of dystonia at the start and on improvement of pain during treatment. [ABSTRACT FROM AUTHOR]

Children with cerebral palsy (CP) or spina bifida (SB) often have executive dysfunction affecting activity performance. With the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach, children find their own way to perform activities, using problem-solving strategies and meta-cognitive thinking. The present study aimed to investigate the effectiveness of the CO-OP Approach in children with CP or SB, compared with conventional rehabilitation, in achieving self-identified activity goals, and to explore any generalization and transfer effects. Randomized controlled trial, CO-OP versus treatment as usual, 38 children (7–16 years) participated. Each child identified four goals (to study generalization and transfer, one remained untrained). Primary outcomes: Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS). Secondary outcomes assessed executive functions and self-rated everyday-life competence. Self-rated goal attainment (COPM) was significantly greater for both trained and untrained goals in the CO-OP group compared with the control group. The rating of observed performance (PQRS) was significantly higher for trained goals in the CO-OP group. The CO-OP group experienced fewer problems in everyday life after treatment. Executive functions did not differ significantly between groups. CO-OP is more effective than ordinary treatment in achieving both trained and untrained goals. CO-OP enables children with CP (MACS levels I–III) or SB without intellectual disabilities to reach self-identified goals. CO-OP shows transfer effects to new activities and situations, which may enhance children's self-efficacy. CO-OP is an important complement to conventional rehabilitation services for children with CP and SB. [ABSTRACT FROM AUTHOR]

Person-centred goal setting with people with brain injury, by interdisciplinary teams has benefits including improved communication between patients, families and clinicians, person-centred care, and improved engagement in rehabilitation. Exploring the experiences of team members who have adopted interdisciplinary, person-centred goal setting may assist in understanding what is needed to implement this complex, core component of rehabilitation practice. This study explored experiences of clinicians working in an extended inpatient brain injury rehabilitation unit about implementing a role-based goal planning approach within an interdisciplinary team. Semi-structured interviews with 13 clinicians working at the rehabilitation unit explored their experiences about the cognitive participation and collective actions required to carry out the practice, with data analysed using inductive content analysis guided by Normalisation Process Theory. Three primary themes were identified: putting the person at the centre, accepting the mind-shift to participation focused goals and working collaboratively. This study has elucidated some key processes that occurred and were necessary to carry out goal setting. A mind-shift towards holistic, participation-focussed goal setting was described as "unlearning" discipline-specific goal setting. Development and ownership by the team, acceptance of team members and willingness to share, and structured processes and resources were necessary. Normalising interdisciplinary role-based goal setting in multi-professional teams requires a mind-shift away from traditional, discipline-specific goal setting. Implementation of interdisciplinary, collaborative team goal setting within health service settings requires collective actions including collaborative working by team members, structured processes including organised time for collaborative team and family meetings, practical resources and training to support processes. Clinicians perceived the goal setting approach to put the person at the centre resulting in a deep understanding of the person, shared understanding, and motivation for rehabilitation. [ABSTRACT FROM AUTHOR]

To review the evidence around self-management interventions used to improve mobility post-stroke. An integrative review was carried out. Eight databases were searched from 1992 to July 2021 using keywords based on the PICOS strategy. Two reviewers independently screened and extracted the relevant data. Quality of studies was assessed and a quantitatively led narrative synthesis of data, supported by qualitative evidence, was then conducted. Twenty-four studies with 823 participants were reviewed. Self-management strategies such as patient education, providing information, goal setting, problem-solving, action planning, self-monitoring, and social support were integrated with rehabilitation therapy to improve mobility post-stroke. The reviewed studies showed improvements in functional mobility and walking ability, self-efficacy, participation in physical activity, and quality of life to various extents. Participants in qualitative studies considered the self-management interventions as a valuable addition to their therapy and perceived the improvement in their mobility following them. There is some evidence that self-management interventions help to improve mobility outcomes post-stroke. Heterogeneity of data in the studies made meta-analysis impossible. Most of the identified studies examined the feasibility and fidelity of the interventions and further research is warranted to examine the efficacy of these interventions to improve functional mobility post-stroke. Self-management interventions can improve mobility-related outcomes, which are considered a priority goal for many stroke survivors. Survivors valued their participation in self-management integrated care programmes and linked that to the perceived improvement in their rehabilitation outcomes. Self-management interventions such as patient education, goal-setting, self-monitoring, and professionals/carers support have been found to improve mobility outcomes for stroke survivors. The outcomes that benefited to a slight extent using self-management were; functional mobility, walking ability (speed, distance, and endurance), and a number of steps per day. [ABSTRACT FROM AUTHOR]

Evaluate the feasibility of person-centered goal setting in people with Parkinson's disease (PD) who have subjective cognitive decline and explore characteristics of the formulated goals. Participants completed person-centered goal setting as a part of two cognitive intervention studies. Participants were guided to develop at least three goals and rate the importance of each goal using a 10-point scale (1: not at all important − 10: extremely important). To evaluate the feasibility of person-centered goal setting, we calculated the mean number of formulated goals per person and the importance level of all goals. To explore goal characteristics, two independent authors coded all goals and synthesized them using deductive content analysis in consultation with the senior author. Thirty participants formulated a total of 166 goals. The mean number of formulated goals per participant was 5.53 (SD = 2.22, range = 3 − 10). The mean importance level of all formulated goals was 8.3 (SD = 1.49, range = 4 − 10). Formulated goals ranged across diverse domains and categories. Person-centered goal setting is feasible to guide people with PD to formulate personally meaningful goals. Findings highlight the diverse cognitive rehabilitation needs of people with PD, potential cognitive rehabilitation priorities, and future goal setting research directions. Rehabilitation clinicians and researchers should not assume that people with PD who have subjective cognitive decline are not capable of engaging in their goal setting. Rehabilitation clinicians and researchers should acknowledge and act on our responsibility to enable people with PD who have subjective cognitive decline to engage in goal setting. Rehabilitation clinicians and researchers are encouraged to explore diverse goal domains to optimize goal setting and rehabilitation care among people with PD who have subjective cognitive decline. [ABSTRACT FROM AUTHOR]

The impact of botulinum neurotoxin-A (BoNT-A) on functional outcomes when managing focal muscle spasticity remains unclear. It is possible that randomised controlled trial (RCT) design and/or reporting may be a contributing factor. The objective of this review was to determine the extent to which RCTs evaluating functional outcomes following BoNT-A align with focal spasticity guidelines. RCTs published from 2010 were included if they targeted focal spasticity, included BoNT-A, randomised a physical intervention to the upper/lower limb, or the primary outcome(s) related to the activity/participation domains of the International Classification of Functioning, Disability, and Health. Data extraction and quality appraisal using the Modified PEDro and Modified McMasters Tool were performed independently by two reviewers. General research practices were also extracted such as compliance with therapy reporting guidelines. Fifty-two RCTs were eligible. Individualised goal setting was uncommon (25%). Six studies (11.5%) included multi-disciplinary management, and five (9.6%) included patient/caregiver education. Four studies (7.7%) measured outcomes beyond 6 months. The Median Modified PEDro score was 11/15. Alignment with focal spasticity guidelines in RCTs was generally low. Our understanding of the impact of focal spasticity management on functional outcomes may be improved if RCT design aligned more closely with guideline recommendations. The influence of BoNT-A on improved functional outcomes is yet to be determined. Individualised goal setting with a multi-disciplinary team is uncommon in an RCT design, despite it being a key guideline recommendation. Given the long-term nature of spasticity management, guidelines recommend short as well as long-term reviews following intervention however RCTs rarely assess beyond 6 months. [ABSTRACT FROM AUTHOR]

We explored the content and attainment of rehabilitation goals the first year after rehabilitation among patients with rheumatic and musculoskeletal diseases. Participants (n = 523) recorded goals in the Patient Specific Functional Scale at admission and reported goal attainment at admission, discharge, and 12 months after rehabilitation on an 11-point numeric rating scale. Goal content was linked to the ICF coding system and summarized as high, maintained, or no attainment. Changes in absolute scores were investigated using paired samples t-tests. Goals had high attainment with a significant positive change (–1.83 [95% CI −2.0, −1.65], p > 0.001) during rehabilitation, whereas goals had no attainment with a significant negative change (0.36 [0.14, 0.57], p > 0.001) between discharge and 12 months after rehabilitation. Goals focusing on everyday routines, physical health, pain management, and social or work participation were highly attained during rehabilitation. Goals that were difficult to enhance or maintain after rehabilitation addressed everyday routines, physical health, and work participation. The positive changes in goal attainment largely occurred during rehabilitation, but they appeared more difficult to maintain at home. Therefore, rehabilitation goals should be reflected in the follow-up care planned at discharge. The contents of rehabilitation goals reflect the complexity and wide range of challenges patients with rheumatic and musculoskeletal diseases experience. Positive changes in goal attainment largely occur during rehabilitation and appear to be more difficult to enhance or maintain at home. Rehabilitation interventions and follow-up care should be tailored to support patients in maintaining their attained goals for healthy self-management. Rehabilitation goals should be reflected in the follow-up care planned at discharge. [ABSTRACT FROM AUTHOR]

Little research has explored the process of disclosure decision-making from antecedents to outcomes. This paper presents a model of decision-making about disclosure of a mental health condition to the immediate supervisor in the workplace shortly after starting a new job. A qualitative descriptive design was employed to explore participants' experiences of the disclosure decision-making process, the disclosure event itself (if applicable), and their perceptions of the impact of the decision on personal, interpersonal, and organizational outcomes. The transcripts were coded and analyzed using directed content analysis. Twenty-eight participants were purposively selected to represent different disclosure decisions, sex, diagnoses, and maintenance of employment. Analysis identified goals and conditions/context were important antecedents for the disclosure decision. All participants discussed concerns about prejudice and discrimination if they disclosed, and, for those who chose to disclose, high stress and anxiety were described during the disclosure event; however, supervisor reactions were generally described as positive. Regardless of the disclosure strategy adopted, participants reported that their disclosure decision helped to support their self-acceptance and recovery. For those who disclosed, most perceived a positive response by their supervisor. However, the pervasive concerns of prejudice indicate there is still much work to be done. Decision-making about disclosure of a mental health condition to the immediate supervisor in the workplace is a complex process. Disclosure goals, the relationship with the supervisor and the workplace context are important antecedents to the disclosure decision. Careful consideration should be given to the planning of disclosure, particularly related to what information will be shared, how it will be shared, and an appropriate level of emotional content to enhance the likelihood of a positive response from the supervisor. Disclosure planning should take the supervisor's style and organizational norms into account. [ABSTRACT FROM AUTHOR]

Acquired brain injury (ABI) is a complex injury which impacts engagement with worker roles. Return to work (RTW) rates for individuals with brain injury are low and those who do RTW often report job instability. Vocational rehabilitation (VR) can improve RTW rates and job stability; however, service provision is varied, and no gold standard has been identified. A systematic scoping review of the literature was completed to explore research activity in VR for individuals with ABI to address the following three questions: what models have been identified to underpin VR in ABI? What clinical processes have been identified to guide provision of VR in ABI? What components of VR have been described and/or recommended in the ABI literature? The number of included articles was 57. From these articles, 16 models, nine process steps, eight components, and four service delivery components were identified that were utilised in provision of ABI VR. Implications for practice are discussed. Key processes and components of ABI VR have been identified across a range of models and apply to clients at all phases post-injury. Findings may be used to inform service provision across a range of time points and support clinicians in their delivery of VR to adults with brain injury. People with acquired brain injury (ABI), even severe injury, can be successful with return to work (RTW) when provided appropriate supports. A wide range of models, interventions, and service components have been identified in the literature which can be used to guide clinical and policy development in ABI vocational rehabilitation. Vocational rehabilitation for individuals with brain injury involves a complex interaction of factors, and consideration should be paid to not only the person and their abilities but also job demands and the environment (physical, social, cultural). Vocational rehabilitation services should be accessible and timed to maximise chances of a successful RTW, provided by a coordinated interdisciplinary team and should involve active stakeholder engagement. [ABSTRACT FROM AUTHOR]

This paper provides recommendations for neurorehabilitative research informed by insights from critical disability studies (CDS) and a research study that tested an augmented neurorehabilitative technology prototype. The methodology combines critical reflection, feminist science studies and CDS to analyze how neurorehabilitation and disability studies conceptualize notions of disability and cure. It offers recommendations for reconciling the conflicting ideologies of cure that operate within neurorehabilitative research. The prototype acted as a kind of virtual reality hope machine that tapped into different emotions and language games regarding disability and cure. The result is five recommendations about the ways that a CDS perspective might inform neurorehabilitation research: (I) ensure clarity in recruitment materials to account for dominant social views on disability and the possibility of cure; (II) build "strong objectivity" into research methods through attention to social context and multiple meanings of terms; (III) engage in critical reflection about research processes and findings; (IV) incorporate principles of crip technoscience; and (V) include CDS perspectives in neurorehabilitation education. Bridging a conversation between neurorehabilitative research and CDS can address the discrepancies between ideologies of cure, and situate rehabilitation within the wider concerns of social determinants of health and disability justice. Bridging connections between rehabilitation studies and critical disability studies can generate productive insights that open up conversations with disabled people and a commitment to disability justice. Disability and cure are social constructs and may have different meanings for patients and rehabilitation professionals. Clinicians should be mindful of the conflicting ideological constructs and socio-political dimensions of disability and cure that are operating below the surface in the rehabilitation profession and in interactions between clinicians and patients. As technology continues to transform clinical rehabilitation care through virtual reality and other innovative paradigms, rehabilitation clinicians should recognize the potential for these technologies to become "hope machines," generating patient expectations that are idealized constructions of hoped-for outcomes of returning to a previous state or level of functionality rather than predictive expectations of likely results. [ABSTRACT FROM AUTHOR]

Identifying the factors impacting physical activity (PA) among adolescents and young adults with cerebral palsy (CP). Four focus groups were conducted, with a total of 22 participants with CP, aged 14–24 years, Gross Motor Function Classification (GMFCS) I–III. Our qualitative analysis drew on grounded theory and used Atlas software. Findings revealed four categories of factors impacting PA: (1) Musculoskeletal-pain and additional impairments related to activity limitations; (2) knowledge and exercising skills, and life skills such as problem-solving, decision-making, planning and organizing; (3) availability: lack of transportation, professional guidance, adapted and community-based programs, especially enjoyable activities; (4) social support from professionals (mainly physiotherapists) and peer support with socializing opportunities. Many opposed parental involvement. Those who attended special education schools and had moderate to severe learning disabilities saw PA as an opportunity for social contacts, limited by lack of availability. Those in mainstream schools with mild to no learning disabilities used PA for relieving pain and preserving function, limited by difficulty balancing PA and life goals. Service providers should inculcate knowledge and active-living skills during the transition to adulthood. Professional guidance needed to ensure inclusion in communal PA and offer adapted programs for young people with CP. There is a need for ongoing, accessible, adapted, community-based physical activity programs for young adults with CP guided by skilled professionals that can provide them with opportunities for enjoyable activities involving social interactions. When planning treatment interventions for children and young individuals with CP, healthcare providers should be aware of past therapeutic experiences and in collaboration with parents, are encouraged to be sensitive to possible tensions which may exist regarding their body care. Healthcare and educational professionals should provide young people with CP and their families with theoretical and practical knowledge about physical activity and its health benefits, as well as information about exercise options. Developing life skills in young adults with CP is important for helping them to effectively engage in physical activity and develop the competencies needed to achieve long term physical care. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines for dementia recommend the provision of rehabilitative or reablement interventions that support functioning. This project sought to develop an assessment guide, centring on goal attainment scaling (GAS), for practitioners to measure attainment of meaningful outcomes for people living with dementia participating in reablement programs. To assist in guide development, two focus groups (people impacted by dementia [n = 10]) explored priority reablement goals. Two further focus groups (allied health practitioners [n = 11]) explored understanding and experience using GAS, opinions on what goals would be realistic, and how an assessment guide could best support practice. The key focus group themes that emerged and which underpinned guide development were: 'what is possible'; 'who sets the goals'; 'practitioner perspectives on using GAS'. Leisure was a key goal priority for people impacted by dementia, and echoed by practitioners. The assessment guide is structured around three steps: choosing goals (using focus group derived Reablement Goal Lists); defining goals (using a new Dementia-specific SMART Framework); scoring goals (using GAS-Light). Providing a structured approach to evaluation of reablement programs for people living with dementia could lead to more consistent service provision, improved outcomes and opportunities for benchmarking. Dementia is a leading cause of disability in older people. Rehabilitative interventions such as reablement are recommended to support functioning in people living with dementia, but there is currently no consistent method of selecting and evaluating attainment of meaningful outcomes. This study describes the reablement goals identified by people impacted by dementia as being most important, along with allied health practitioner views on goal-setting and the use of Goal Attainment Scaling (GAS). Study findings were used to develop a structured assessment guide employing three steps: choosing reablement goals; defining those goals using a new dementia-specific SMART Framework; and scoring goals using GAS-Light. A consistent approach to goal selection and evaluation of attainment for people impacted by dementia participating in reablement programs may lead to more effective rehabilitative interventions in this group. [ABSTRACT FROM AUTHOR]

To seek physiotherapists' perspectives on patient adherence to exercise prescription for falls prevention/risk reduction in the Singapore setting. Three focus groups with physiotherapists (n = 16) were conducted. An inductive thematic analysis was performed to identify main themes by four independent researchers. Three main themes emerged: "it's about the patient," "delivery of the programme," and "carer/family support and facilitation." Physiotherapists believed that adherence was all about the patients' mindset and motivation, and they had to tailor interventions to optimise adherence to cater for patients as distinct characters, with different health/cultural beliefs and ability to prioritise time. Furthermore, physiotherapists reported better patient adherence when therapy goals referred to maintaining function rather than reducing falls. Families/carers can act as facilitators while providing practical and/emotional support further enhanced exercise adherence. Awareness of the perspectives of physiotherapists in identifying and addressing patients' adherence to exercise may better equip researchers and healthcare providers in developing culturally relevant interventions that promote exercise adherence in Singapore. Certainly, adherence varies widely among patients receiving the same treatment. Analysis of predictive factors of non-adherence will assist to tailor intervention. Physiotherapists believe the use of individualised approaches that adapt to patients and their health beliefs are critical for exercise adherence in older people in Singapore to prevent falls and falls risk. Adherence to exercise is multi-factorial: physiotherapists need to include attention to education, building rapport and facilitating practical and emotional family/carer support. Non-adherence is not merely a patient problem but is influenced by both clinicians and the healthcare system in Singapore/Southeast Asia. [ABSTRACT FROM AUTHOR]

The pursuit of independent living outcomes has been a longstanding emphasis of disability policy, practice, and research. Yet the ways in which the experience of independent living is understood and advanced locally warrants more focused attention. This article describes a collaboration among a regional Center for Independent Living (CIL) and university researchers focused on developing more informed programs and supports to promote independent living for persons with disabilities in their service area. A total of 75 adults with disabilities attended four "community conversations" during which they provided diverse definitions of independent living and shared a wide range of supports they needed and currently accessed to meet their independent living goals. Attendee conversations generated 14 unique dimensions of independent living and 11 categories of independent living supports. Findings align with existing research asserting independent living as a multifaceted construct and extend the literature to include perspectives across a wider range of disability categories. This study suggests that collaborations among Centers for Independent Living and researchers can be a fruitful context for conducting "needs assessments" and soliciting the perspectives of individuals with disabilities on (a) how they conceptualize independent living and (b) the local services and supports they need to attain their independent living goals. Community conversations are an efficient and engaging way of soliciting the perspectives of community members with a variety of disabilities. Establishing a planning team fluent in universal design, accessibility options, and local needs is critical to implementing effective community conversations. For Centers for Independent Living (CILs), community conversations offer a valuable approach for obtaining substantive stakeholder input to inform strategic planning. CILS could play an active role in equipping transition-age students with the skills, knowledge, relationships, and linkages needed to attain their independent living goals in early adulthood. [ABSTRACT FROM AUTHOR]

Participation is a key outcome of rehabilitation. However, no reviews have investigated the impact of low vision on the activities, participation, and goals of older adults. This paper aims to review and synthesize available literature on how low vision impacts the activity and participation of older adults. A scoping review was conducted. The key findings were extracted from 30 full-text articles that met the selection criteria. The International Classification of Functioning, Disability and Health was used to frame the findings at the activity and participation levels. At the activity level, the categories of Walking, Moving around in different locations, and Reading were commonly impacted by low vision. The main domains impacted at the participation level were Community, social and civic life and Interpersonal interaction and relationships. Only one study addressed the goals of older adults with low vision. Low vision impacts reading, walking, and moving around in different locations. Rehabilitation therapists should be aware of and consider assessing these activities. Further research is needed on the impact of low vision on other functional activities, participation, and self-identified goals of older adults to guide clinical practice. Low vision has an impact on the activity level of older adults, consistently identified in the areas of walking and moving around in different locations and reading for knowledge and leisure. At the participation level, the impact of low vision is less frequently identified compared to the areas identified at the activity level, in the areas of leisure, social interactions and basic and instrumental ADL. Rehabilitation therapists working with older adults with low vision should assess clients' performance of moving around in different locations, in addition to walking, and include screening questions on the impact of low vision on driving. Rehabilitation therapists working with older adults with low vision should determine clients' reading needs and acquire competence in assessing clients' reading ability and providing intervention for different types of reading to enable them to continue participating in various life situations that require the performance of reading. [ABSTRACT FROM AUTHOR]

Goals are vital in rehabilitation; however, how goal-setting occurs varies widely in clinical practice. This study aims to review goal-setting practices across the rehabilitation continuum within varied case mix services in Queensland, Australia. A descriptive multisite qualitative case study with medical record audits and interviews of adult rehabilitation clients was used to evaluate four propositions across three inpatient and two community rehabilitation services. The propositions evaluated the process in which goal-setting occurs, action planning and review of goals, as well as the type, specificity and client-centeredness of goals set. Goals (n = 1120) were often poorly defined, focussed on short term physical functioning and were predominantly set by individual disciplines with the client rather than using an interdisciplinary approach. Clients were not consistently given action plans to pursue goals (n = 59, 18%) and the review of goal progress (n = 60, 18%) was limited. Few clients reported receiving copies of their rehabilitation goals (n = 16, 25%). Goal-setting in rehabilitation should be specific, meaningful and include the client in action planning, feedback and review. However, goal-setting in rehabilitation is often multidisciplinary and unstructured. Best-practice rehabilitation team goal-negotiation and goal-setting should include a common goal focus and incorporate components of staff and client action planning, coping planning, feedback and review. Rehabilitation clients prefer shared-decision making approaches to setting meaningful and personalised goals, however, require time and support to engage in the goal-setting and negotiation process. Rehabilitation clinicians need training and support to improve their goal negotiation and goal writing skills to create specific, understandable and meaningful goals with rehabilitation clients. [ABSTRACT FROM AUTHOR]