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The importance of goal-setting in rehabilitation

At a glance:
Goal setting, when aided by the individual's motivations, can improve the outcome of rehabilitation. The employee, in conjunction with their treater and/or employer, can set manageable goals as part of a return to work process.
Perspectives:
Employee
Most people return to work without difficulty and rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 is uncomplicated. However, when the health condition is longer term and returning to work is complex, rehabilitation can be more difficult. Rehabilitation works best when you understand the process, are actively engaged, and can see "what's in it for you". Setting goals can aid motivation by allowing you to see where you are heading and know that the challenges are realistic. A return to work plan will often include goals, such as working a certain number of hours per week by a certain date.

People who have been off work for long periods often look back and say they wish they had done things differently in the early stages of the problem, and returned to work then. Being off work for long periods causes other personal problems, it impacts family relationships, income and personal pride.

Goals can be used to accomplish immediate physical tasks, such as a return to full work duties. They can also be used to achieve things that may be less directly related to the return to work, such as the mastery of difficult life skills, using the opportunity to develop your communication skills, or to be a role model for others in your family about how to deal with a difficult situation.

This is not to detract from the importance of your condition and resolving the medical issues. Appropriate management of the medical factors is important, along with the rehabilitation approach to return to work.
Employer
Understanding the perspective of the individual returning to work (or remaining at work with a work-related health condition) enhance relationships and improves outcomes. Goal setting and rehabilitation is most successful when it is undertaken as a shared experience.

When individual and personal factors are considered in goal setting, motivation is increased. For example, return to work plans typically include a staged increase in hours of work. A preferred goal would be the individual feeling that they are contributing to the team.

Return to work discussions may be slightly different when self esteem and service to other are considered among the goals. These are personal feelings rather than an objective measure, but for many people these sorts of goals will carry a lot more meaning and provide greater motivation and focus for a return to work.
Treater
Goal setting is used in a very limited way in work rehabilitation. Return to work plans typically set out a timeline for an increase in hours and increasing duties.

Productive use of goal setting in rehabilitation is an under-utilised area. Most people return to work without difficulty and the rehabilitation path is uncomplicated and smooth. However for people who have long-term problems and remain off work for some time an active approach to rehabilitation is important. Many people who have been off work for long periods look back and believe that if only something more had been done earlier, they wouldn't be in their current position.

Included in this Knowledge Base are a broad range of studies that evidence the negative health effects when people remain off work. Lives become dysfunctional, marriages break down, and finances become strained. People suffer emotionally, financially and physically.

Letting people know about the negative consequences of being off work is important. We tell people about the risks in the early stages of their diabetes and asthma, but not in the early stages of being off work. Honest communications about the long-term consequences of being off work and the long-term consequences of modified duties, help people understand the path forward.

Goal setting within a return to work can be broken down into short-term goals, such as the goal to return to work, or to return to preinjury tasks by a certain date. Broader goals may be reintegration with the team at work and feeling part of the workplace. Other goals may be less directly related to the return to work, such as the mastery of difficult life skills, using the opportunity to develop communication skills, or to be a role model for others in the family about how to deal with a difficult situation.

As the authors of this study indicate, motivations that are drawn from the person are stronger and provide a higher sense of well-being when they are achieved. To set these types of goals requires a deep understanding of the individual and this can take time. A strong relationship and ability to communicate with that person is important in the development of these deeper goals.
Insurer
Goal setting is used in a very limited way in work rehabilitation. Return to work plans typically set out a timeline for increasing hours and increasing duties. Unfortunately goals that have a psychosocial
psychosocial
Refers to psychological and social factors. Examples of psychosocial factors that affect return to work area include: a person's beliefs about how they will cope with their condition, the attitude of the inured worker's family to their condition and return to work, the employer's return to work policy and the influence of the WorkCover system on a person.
 objective, such as contributing to the team, or improving family life, are rarely used.

Most people return to work without difficulty and the rehabilitation path is uncomplicated and smooth. However for people who have long-term problems and remain off work for some time an active approach to rehabilitation is important. People who have been off work for long periods tend to look back and think that if only more had been done in the early stages their position would be improved.

Included in the Knowledge Base area broad range of studies that indicate the negative health effects when people remain off work. Lives become dysfunctional, marriages break down, and there are negative financial consequences for many people.
Original Article, Authors & Publication Details:
R. J. Siegert* and W. J. Taylor (2004).

Theoretical aspects of goal-setting and motivation in rehabilitationDisability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 & Rehabilitation; 26(1):1 – 8

*Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington South, New Zealand
Background, Study Objectives, How It Was Done:
Rehabilitation is the process of helping people to regain their pre-injury abilities and quality of life, or as close as is realistically possible.

Rehabilitation is primarily a practical, task-orientated approach. It is an effective way to help people regain function. However, from time to time it is important to think about the theoretical framework of rehabilitation in order to develop new concepts and theories to inspire new treatment approaches.

This article looks at the goal setting component of rehabilitation. It reviews research about rehabilitation and introduces new ideas about the process of goal setting.
Study Findings:
It is accepted that goal setting is an important component of rehabilitation. A range of studies have demonstrated that it is effective, but when goals are vague rather than precise the outcomes are not as successful.

Goal setting should be a collaborative process, in which the individual, treater and rehabilitation team agree on a set of shared goals. Goal setting is dynamic and goals can be changed and adjusted. Developing short, medium and long-term goals assists rehabilitation.

Areas where goal setting can be improved:

The patient should play an active role in the process of setting goals. When the patient doesn't set their own goals they are less likely to be determined to reach their targets.
Health professionals tend to frame goals in terms of physical outcomes. Setting psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 goals is relatively rare.
The outcomes of rehabilitation that are important to health professionals and patients can differ significantly. If these issues are not adequately discussed rehabilitation may be less successful.

Goal setting as a process is based on working towards a future outcome. It implies the individual is in a position to look forward in time, at steps, actions and objectives to be achieved in the future. Not all people work in this way. For goal setting to have meaning the patient must understand the process and be able to think forward in time.

Motivation is affected by factors inside the individual, such as the individual's focus and needs. It is also affected by external factors, such as rehabilitation team qualities, the person's social support network, or workplace issues. Motivation is a combination of these internal and external factors. The authors note that one of the difficulties with the concept of motivation is that a moralistic stand can blame the patient.

After evaluating the literature on motivation the authors argue that motivation and goal setting requires a deep understanding of the way people operate. The authors quote that people require:

Autonomy, the ability to organise their experiences and live in a way they feel whole and complete as a person
Relatedness, the ability to establish emotional connectedness to other human beings, and to feel loved and cared for
Competence, the ability to feel confident about one's living environment.

Rehabilitation and goal setting needs to be holistic in its approach, focusing not only on the short term goals, but on the person's overall needs. If the focus of goal setting is narrow, then the individual's enthusiasm and determination to achieve their goals may be diminished.

The authors note that if goal setting is based in internal motivating factors, the person's sense of competency and self-determination will be increased. In turn this means that the person needs to be understood, to set meaningful goals in a rehabilitation process.

Goals that are challenging, but not too easy are associated with positive well-being. Studies indicate that higher subjective well-being is associated with achieving positive goals, but improved well-being is not achieved through avoidance of goals.

An individual's goals often relate to their personal beliefs or personal striving. For example one person may value physical attractiveness and devote time and energy to diet, exercise, and grooming. Another person might strive to be a good person, while others seek to do well in their career. The strivings reflect what a person is characteristically trying to achieve.

Goals play a central role in determining the degree to which a person is satisfied with his or her life. The degree to which the person is fulfilling their goals will influence their emotional state. An individual's emotions are an important part of the goal setting process and should not be ignored. Emotions allow the rehabilitation professional an opportunity to discuss the person's satisfaction with the rehabilitation process. Emotions enable deep discussion and may enable the individual to make larger decisions about changing the rehabilitation program, where appropriate.

A depressed patient in rehabilitation may require management of their depression
depression
A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 before active rehabilitation. Depressed mood alters how an individual processes information. Depressed people may have bitter memories and negative thoughts making it difficult to find positive memories to use in the process of developing new goals. They may have difficulty in developing a concept for a positive future. The practical implications for this in rehabilitation are that goal setting may be impractical or unproductive.
 
Conclusions:
Goal setting is an important component of rehabilitation. It provides a framework for people and the associated rehabilitation professionals to work together to support the person back to their pre-injury lifestyle, or as close as possible.

Rehabilitation can focus on short-term task oriented goals. Focusing on internal motivating factors and a range of goals may provide a greater level of personal satisfaction and motivation.
References:
PubMed Abstract
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