Characteristics of goal-setting tools in adult rehabilitation: A scoping review.

OBJECTIVES: This scoping review aims to map the literature on goal-setting tools in adult rehabilitation, exploring their characteristics, target users and supporting evidence to inform practice and future research in this area. METHODS: We completed a comprehensive search of four databases to identify relevant articles on tools for goal setting in rehabilitation. We followed Arkey and O'Malley's scoping review process to guide article selection, data extraction and data analysis. RESULTS: We identified a total of 165 studies that reported on 55 different goal-setting tools, including tools for goal selection and goal documentation (n = 31), goal setting and intervention planning (n = 15), and for measuring the quality of the goal-setting process (n = 9). Over half of the tools were primarily designed for use in rehabilitation of physical disabilities (n = 32). Some tools fell under multiple sub-categories based on their characteristics as follows: 22 framework tools, 12 interview tools, 9 outcome measurement tools for goal achievement, 6 outcome measurement tools for goal quality and 25 documentation tools. The majority of goal-setting instruments targeted goals at the level of activity and participation (n = 51) and aimed to facilitate a client-centred or shared decision-making approach to rehabilitation planning (n = 46). CONCLUSIONS: This study provides a comprehensive overview of existing goal-setting tools, highlighting their characteristics, target users and identified needs. These findings can enhance practitioners' awareness of the range of goal-setting tools available and can enable more effective utilization of these tools in clinical practice. Further research should investigate how clinicians can combine multiple tools to deliver goal setting.

Response Shifts in the Canadian Occupational Performance Measure: A Convergent Mixed-Methods Study.

IMPORTANCE: A response shift (RS) is a phenomenon in which there is an individual perceptual gap between pre and post assessments. RS effects were not considered in the Canadian Occupational Performance Measure (COPM) development process. OBJECTIVE: To detect the effects of RS on the COPM. DESIGN: Convergent mixed-methods research. SETTING: Subacute rehabilitation hospital in Japan. PARTICIPANTS: Nineteen adult patients with a range of neurological and musculoskeletal conditions recruited from a subacute rehabilitation hospital. OUTCOMES AND MEASURES: In the qualitative analysis, patients' perceptions regarding occupation identified by the COPM were compared between the initial assessment (Time 1 [T1]) and a reassessment (Time 2 [T2]). In the quantitative study, patients were asked to re-rate the occupations in which the RS had occurred, giving feedback on their perceptions at T1 (T2'). The difference between T2 and T2' was calculated to clarify the magnitude of the RS. RESULTS: Of the 19 patients, 18 had an RS in at least one occupation. The RS effects were classified into five categories: Replacing, Adding, Reducing, Unspecified, and Embodiment. Ninety occupations were extracted from all the patients, and 46 (51.1%) were affected by RS. The percentages of occupations for which the change in score due to RS exceeded the minimal clinically important difference (±2 points) was 26.1% (12 of 46) for COPM-Performance scores and 30.4% (14 of 46) for COPM-Satisfaction scores. CONCLUSIONS AND RELEVANCE: Diverse RS effects have been identified in the COPM, which also affect score interpretation. Plain-Language Summary: The Canadian Occupational Performance Measure has a potential measurement bias that is due to a response shift in which there is an individual perceptual gap between pre and post assessments. The results of this study reveal a need to establish more accurate measurement methods to reduce the impact of response shifts on COPM scores.

The clinical utility of a decision-aid to facilitate the use of the hand in real-life activities of patients with distal radius fractures: A case study.

BACKGROUND: Occupation-based intervention (OBI) in hand therapy has shown superior benefits in patient-reported performance and physical measures; however, only a few studies have used OBI. We developed a decision-aid to promote the use of an injured hand in the real world (Aid for Decision-making in Occupation Choice for hand; ADOC-H) PURPOSE: To investigate the clinical utility of the ADOC-H (paper version) in patients with distal radius fractures. STUDY DESIGN: A prospective case series and a clinical survey for occupational therapists. METHODS: This study comprised a prospective patient case series of 8 patients with distal radius fractures, treated using Volar locking plates, and a clinical survey of 4 experienced occupational therapists. RESULTS: No patient or therapist complaints or drop-outs were reported. Active range of motion (wrist), Grip strength, and Disabilities of the Arm, Shoulder, and Hand scores improved for all patients. The ADOC-H induced 158 activities using the injured hand, with activities of daily living (69.8%) selected earlier in the treatment period, and instrumental activities of daily living (63.3%) selected later. The feedback and case studies suggested that the ADOC-H was useful for patients who were afraid of using the hand and, interestingly, patients who were able to use their hand without pain or other problems. The clinical survey showed that most therapists found the ADOC-H effective in facilitating real-life use of an injured hand. CONCLUSIONS: The ADOC-H paper version is an useful tool that can be applied to facilitate patients with distal radius fractures to use their injured hands in real-life settings.

Measurement Properties of the Canadian Occupational Performance Measure: A Systematic Review.

IMPORTANCE: The Canadian Occupational Performance Measure (COPM) is widely used in clinical practice and research. However, the measurement properties of the COPM were not reviewed using rigorous systematic methodology. OBJECTIVE: To evaluate the measurement properties of the COPM. DATA SOURCES: MEDLINE, Web of Science, Scopus, OTseeker, and Cochrane Library. Study Selection and Data Collection: We used the updated COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist to evaluate the measurement properties of the COPM reported in relevant studies. FINDINGS: Our search identified 35 articles that reported measurement properties for the COPM with samples that differed in age, country, diagnosis, and disease stage. For content validity, the evidence was inconsistent and of low quality; no studies assessed structural validity. For reliability, the internal consistency was indeterminate and of low quality. One study reported indeterminate and very low quality evidence for cross-cultural validity. According to the evidence reported in these studies, the COPM has inconsistent and moderate reliability, construct validity, and responsiveness and insufficient and high-quality evidence for criterion validity. CONCLUSIONS AND RELEVANCE: Our review of the evidence using the COSMIN Risk of Bias checklist indicates that the Canadian Occupational Performance Measure lacks high-quality validation. What This Article Adds: High-quality validation of the Canadian Occupational Performance Measure is lacking. Further examination of its measurement properties using updated relevant guidelines is required.

Comparison of occupation-based and impairment-based occupational therapy for subacute stroke: a randomized controlled feasibility study.

OBJECTIVE: To compare occupation-based and impairment-based approaches in occupational therapy and determine the feasibility of patient recruitment and retention. DESIGN: A multicenter, randomized, controlled pilot trial with a single blind assessor. SETTING: Ten subacute rehabilitation units in Japan. PARTICIPANTS: Fifty-four patients with subacute stroke. INTERVENTIONS: The experimental group used the iPad application, Aid for Decision-making in Occupation Choice, to establish occupation-based goals, and evaluation and intervention were conducted mainly through real occupations. The control group was evaluated according to patients' generic abilities and activities of daily living (ADL), and the intervention mainly involved the impairment-based approach. MAIN OUTCOME MEASURES: Short Form-36, Functional Independence Measure, Brunnstrom recovery stages, The Client Satisfaction Questionnaire, and length of hospital stay. RESULTS: Of the 1465 potential participants, 54 (3%) subacute stroke patients were enrolled over 16 months and 68% (n = 36) were retained to the 2-month assessment: experimental group (n = 16); control group (n = 21). Although there was no significant intergroup difference for any outcomes, the experimental group had a small effect size advantage on the Short Form-36 "General health" (d = 0.42) and "Role emotional" (d = 0.43) subscales relative to the control group. A sample of 118 subacute stroke patients per group would be required for a lager study. CONCLUSIONS: Results suggest that the occupation-based approach has more potential to improve "General health" and "Role emotional" scores on the Short Form-36 than the impairment-based approach. Further investigation of study protocol with interventions and recruiting is needed prior to a larger trial.

Longitudinal Process of Setting and Achieving Activity- and Participation-Level Goals in Home Rehabilitation in Japan: A Qualitative Study Using Trajectory Equifinality Modeling.

This study aimed to clarify the longitudinal goal negotiation and collaboration process of achieving activity- and participation-level goals. We conducted a qualitative study using the trajectory equifinality model. Nine occupational therapists with experience in setting and achieving activity- and participation-level goals were recruited and interviewed about their clients. We identified two phases and four pathways in the setting and attainment process for activity- and participation-level goals. Throughout the longitudinal goal-setting process, when the occupational therapist and client had difficulty discussing activity- and participation-level goals, the therapist respected the client's expectations, explained the purpose of occupational therapy in detail, and conducted individual face-to-face interviews. When it was difficult to provide work-based interventions, the occupational therapist made flexible use of functional training, elemental movement training, occupation-based practice, and environmental modifications. The results of this study may assist in supporting clients to improve their activity and participation in home rehabilitation.

The Conceptual Analysis of Collaboration in the Occupational Therapy by Combining the Scoping Review Methodology.

BACKGROUND: Collaboration is an important concept in goal-setting in occupational therapy. However, this concept is not stable due to various definitions. The purpose of this study was to clarify the concept of collaboration in occupational therapy. METHOD: A scoping review was used to search for all articles related to occupational therapy and collaboration. PubMed, Web of Science, CINAHL, and OT Seeker searches were conducted using predetermined keywords. Three examiners independently reviewed and assessed the quality of each study using Walker and Avant's concept analysis method. RESULTS: Results of the database searches yielded 1873 studies, 585 of which were deemed eligible to include in this review. Results showed five attributes ("active participation for the common objective", "existence of something to share", "matured communication and interaction", "relationship founded on the respect and trust" and "complementing each other") and two antecedents and several consequences. CONCLUSIONS: Our findings may contribute to collaborative goal-setting and occupational therapy.

Examining minimal important change of the Canadian Occupational Performance Measure for subacute rehabilitation hospital inpatients.

BACKGROUND: The Canadian Occupational Performance Measure (COPM) is an individualized patient-reported outcome designed to evaluate the self-perceptions of a patient's occupational performance. Our study aimed to examine the minimal important change (MIC) in inpatients undergoing subacute rehabilitation. The MIC values were calculated using the three different anchor-based analyses with the transition index as an external criterion; the mean change method (MICMeanChange), the receiver operating characteristic (MICROC) analysis, and the predictive modeling method adjusted for the proportion of improved patients (MICadjust). In this study, the MICadjust value was considered as the most valid statistical method. We recruited 100 inpatients with various health conditions from subacute rehabilitation hospitals. Data were collected twice: an initial assessment and a reassessment one month later. The systematic interview format (Five Ws and How) was used for both the initial and second assessments to prevent information bias (response shift). RESULTS: Three patients who indicated deterioration on the transition index were excluded from all analyses, and 97 patients were analyzed in this study. The MICadjust values were 2.20 points (95% confidence interval 1.80-2.59) for the COPM performance score and 2.06 points (95% confidence interval 1.73-2.39) for the COPM satisfaction score. The MICMeanChange and MICROC values were considered less reasonable to interpret because the proportions of the improved patients subgroup were more than 50% (82.5%). CONCLUSIONS: The MICadjust value estimates from this study can help detect whether the patients' perceived occupational performance improved or did not change. The results support the multidisciplinary use of COPM in clinical practice and research on subacute rehabilitation inpatients.

Determining whether occupational therapy goals match between pairs of occupational therapists and their clients: a cross-sectional study.

PURPOSE: This study examined the degree to which goals perceived by occupational therapists (OTs) matched those perceived by their clients. METHODS: A total of 100 clients and 79 OTs were recruited from seven subacute rehabilitation wards in Japan. Matched pairs of OTs and their clients were independently asked for their perception about the clients' occupational therapy goals through semi-structured interviews. RESULTS: Collectively, the OTs reported 239 goals, while the clients reported 161 goals. While both the OTs and the clients reported a high level of client engagement in the goal setting process, 79% of the goal statements were mismatched between pairs of OTs and their clients. Goal matching was slightly better for goals about activities of daily living or participation than for goals about body structure or body function. CONCLUSIONS: Although most OTs and their clients perceived that they engaged in goal-setting together, only 21% of reported goals actually matched between OTs and clients. It would also be worth investigating whether there is any correlation between the content of goals, patient engagement in goal setting, degree of goal matching, and health outcomes achieved by clients following discharge from rehabilitation services.Implications for rehabilitationAlthough most occupational therapists (OTs) and their clients perceived that they engaged in goal-setting together, 79% of the goals independently reported by OTs and their clients did not match in seven post-acute rehabilitation wards across Japan.Goals were slightly more likely to match if the topic of the goals related to instrumental activities of daily living or participation (30.3%) or basic activities of daily living (24.7%) than if the topic of the goals were about body structure or body function (11.2%); however, the overall rate of goal matching was low.Japanese OTs need to develop more effective methods for recording or communicating goals in ways that clients can understand; this may be the same for other countries.

Psychological Effects of Hands-On Training Using Public Transportation among Inpatients with Physical Disabilities: Analysis of the Self-Efficacy and Perception of Occupational Enablement Using a Multimethod Design.

INTRODUCTION: This study is aimed at understanding how practicing the use of public transportation can affect the self-efficacy and perceptions of occupational enablement among patients with physical disabilities in a recovery rehabilitation hospital. METHOD: We recruited 21 inpatients with physical disabilities caused by stroke or orthopedic diseases from a recovery rehabilitation hospital in Japan and used a multimethod design including an intervention study and a follow-up survey. The intervention study utilized a before-after trial and provided hands-on training in the use of public transportation as the intervention. How self-efficacy and perceptions of occupational enablement changed before and after the intervention was measured using the visual analog scale (VAS). The follow-up survey was conducted to investigate whether patients used public transportation postdischarge. RESULTS: Only differences in the VAS scores regarding self-efficacy were significant between before and after the hands-on training in the use of public transportation, whereas differences regarding the perceptions of occupation enablement were not. Self-efficacy after the intervention was higher than that before the intervention. In the follow-up survey, both VAS scores of the psychological factors were significantly higher in the group that used public transportation postdischarge than in the group that did not. CONCLUSION: Providing hands-on training in the use of public transportation for inpatients with physical disabilities increased their self-efficacy, indicating that psychological factors should be evaluated to predict their occupational skill improvement and to verify the outcomes of an occupational therapeutic intervention.

Reliability and validity of on-road driving tests in vulnerable adults: a systematic review.

The on-road driving test is considered a 'gold standard' evaluation; however, its validity and reliability have not been sufficiently reviewed. This systematic review aimed to map out and synthesize literature regarding on-road driving tests using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Cochrane Library, PubMed, CINAHL, and Web of Science databases were searched from initiation through February 2018. All articles addressing reliability or validity of on-road driving tests involving adult rehabilitation patients were included. The search output identified 513 studies and 36 articles, which were included in the review. The Washington University Road Test/Rhode Island Road Test, performance analysis of driving ability, test ride for investigating practical fitness-to-drive, and K-score demonstrated high reliability and validity in regard to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The Washington University Road Test/Rhode Island Road Test and test ride for investigating practical fitness-to-drive were analyzed based on Classical Test Theory techniques, and performance analysis of driving ability and K-score were analyzed based on Item Response Theory techniques. The frequency of studies were Washington University Road Test/Rhode Island Road Test (n=9), Test Ride for Investigating Practical fitness-to-drive (n=8), performance analysis of driving ability (n=4), and K-score (n=1). From the viewpoint of accuracy and generalization, the Washington University Road Test/Rhode Island Road Test, test ride for investigating practical fitness-to-drive, and performance analysis of driving ability were identified as highly qualified concerning on-road driving tests. However, the ability to assess real-world driving depends on various environmental conditions.

Effectiveness and Cost-Effectiveness of Occupation-Based Occupational Therapy Using the Aid for Decision Making in Occupation Choice (ADOC) for Older Residents: Pilot Cluster Randomized Controlled Trial.

BACKGROUND: Care-home residents are mostly inactive, have little interaction with staff, and are dependent on staff to engage in daily occupations. We recently developed an iPad application called the Aid for Decision-making in Occupation Choice (ADOC) to promote shared decision-making in activities and occupation-based goal setting by choosing from illustrations describing daily activities. This study aimed to evaluate if interventions based on occupation-based goal setting using the ADOC could focus on meaningful activities to improve quality of life and independent activities of daily living, with greater cost-effectiveness than an impairment-based approach as well as to evaluate the feasibility of conducting a large cluster, randomized controlled trial. METHOD: In this single (assessor)-blind pilot cluster randomized controlled trial, the intervention group (ADOC group) received occupational therapy based on occupation-based goal setting using the ADOC, and the interventions were focused on meaningful occupations. The control group underwent an impairment-based approach focused on restoring capacities, without goal setting tools. In both groups, the 20-minute individualized intervention sessions were conducted twice a week for 4 months. MAIN OUTCOME MEASURES: Short Form-36 (SF-36) score, SF-6D utility score, quality adjusted life years (QALY), Barthel Index, and total care cost. RESULTS: We randomized and analyzed 12 facilities (44 participants, 18.5% drop-out rate), with 6 facilities each allocated to the ADOC (n = 23) and control (n = 21) groups. After the 4-month intervention, the ADOC group had a significantly greater change in the BI score, with improved scores (P = 0.027, 95% CI 0.41 to 6.87, intracluster correlation coefficient = 0.14). No other outcome was significantly different. The incremental cost-effectiveness ratio, calculated using the change in BI score, was $63.1. CONCLUSION: The results suggest that occupational therapy using the ADOC for older residents might be effective and cost-effective. We also found that conducting an RCT in the occupational therapy setting is feasible. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000012994.