What type of long-term rehabilitation goals should we set with our patients in rehabilitation? I have previously argued that they should be made at the level of social participation,...
I have already considered practical aspects of rehabilitation planning on a page within the site; the page is centred on the team meetings involved. The posts in this group are primarily concerned with broader issues.
Rehabilitation is a complex intervention in that it includes many variables that interact, one with another, often bidirectionally and with the nature and extent of a single interaction being determined by other variables. The outcome of changing a single variable is unpredictable. Because of the interdependence of most interventions, with the order in which they occur being crucial in some cases and giving them collaboratively being vital in other cases, planning has an essential role. Moreover, rehabilitation is often ineffective without an agreed set of goals, especially long-term ones. Considerable attention has been given to setting goals, but other aspects of planning could be better studied. Posts in this category will cover all aspects of planning.
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A common complaint about rehabilitation is that more time is spent in meetings than any other activity; I have heard colleagues say, “I did not train just to sit in or chair meetings.” This sentiment overlooks the crucial role of meetings, being the only opportunity for all professions to meet, share information, agree on a formulation, and sketch out a plan that should cover the long-term and short-term issues. This plan is the patient’s rehabilitation curriculum, a term suggested to me by a patient’s father, which nicely acknowledges the significant educational role of the rehabilitation team for the patient, family members, and carers.
A plan is the essential first step when undertaking any complex intervention. It is crucial when acting within a complex system such as the health and social care environment.
Two aspects of rehabilitation planning have been researched. There are many articles on goal setting, how to undertake it, a systematic review of its effects on patient outcome, a systematic review of the underlying theories, reviews of goal attainment scaling and investigations of the types of goals set.
There has also been some research into the structure and running of planning meetings, but the studies are descriptive, and I am unaware of any evaluating what structures are better.
Many areas have yet to be researched, as far as I know. For example, would Gannt charts be a helpful way of monitoring the delivery of a rehabilitation plan, and at what intervals should a plan be reviewed and revised? Should we undertake formal ‘time-limited treatment trials’ with a defined endpoint and specified options dependent on the result regularly? How should one incorporate vital people not part of the rehabilitation team?
Learn from others.
Planning is a universal human activity. We plan holidays, an unexpected party to surprise someone or an invasion of another country. All planning involves foreseeing the future and what might happen if we do this or that. Most planning involves other people. Plans can include committing significant resources or taking considerable risks. It can be a serious business.
Many people and organisations research planning and how to increase its effectiveness. In 1986, shortly after I started work as a consultant, we set up a working party to improve our planning. One member’s father worked in business, and she introduced goal-setting into our planning process. Odd though it may seem, we did not pay any attention to setting goals before her proposal, which led to papers describing our goal-setting process.
We learned from business experience serendipitously. We could be more systematic. One area where rehabilitation has learned from other disciplines is in setting goals. The paper by Locke and Latham, based on years of experience in management studies, has been influential. However, there are doubtless studies on how best to organise and run meetings, monitor progress against plans, and so on that we could learn from.
Rehabilitation planning posts.
The most recent eight posts on rehabilitation planning are below; more can be loaded using the button at the end.