[Patient goals for medical rehabilitation - overview of the current state of research in Germany].

GOALS

It is widely known that goals and goal agreement are important components of a modern approach to medical rehabilitation. The present work gives an overview of the current state of research regarding patient goals for medical rehabilitation by reviewing relevant German pub-lications between 2000 and 2010. This review focused on (1) data collection methods of rehabilitation goals, (2) patient goals, and (3) agreement between the goals of patients and their clinicians.

METHODS

A search strategy combining electronic databases and hand search was applied. A priori inclusion and exclusion criteria were applied. A self-developed goal-catalogue was used to synthesize the literature.

RESULTS

A total of 20 publications were included, 11 of which explored both patient and clinicians perspectives. ad (1): Only 4 goal-assessment instruments in the field of medical rehabilitation exist, but none has been established as a standard. The instruments differ in how differentiate they depict different goals areas. ad (2): The goal structure of medical rehabilitation patients corresponds to the respective indications. The 3 top goals in all patient groups included physical and/or psychosocial objectives. Information and occupational goals are rarely represented among the 3 top goals mentioned. ad (3): Patients have more numerous as well as differing goals then their treating clinicians. Goals of physical functions (e. g., enhancement of stamina) and superior rehabilitation goals (e. g., return to work) have the best agreement. Mental and maintenance goals are more frequently mentioned by the patients while pain and symptom-related goals are more frequently mentioned by the doctors. There are indication-specific differences for goals regarding information.

CONCLUSION

Rehabilitation goals are highly valuable in the rehabilitation process. Finding only 20 relevant publications, generalizability of study results is limited. Due to high variability in methodological approach and presentation of results, comparisons of results across studies reviewed are severely limited. Developing survey standards and using uniform metrics could contribute to standardizing study endpoints. The goals of patients and clinicians are formed in individual life or work contexts, which are influenced by numerous factors (e. g., knowledge, illness/health concepts, assumptions regarding rehabilitation treatment), representing individual expertise that complement one another. Since compatible goals are essential for successful rehabilitation treatment, an exchange of goals and expectations as well as the establishment of joint target agreements should precede any rehabilitation programme.