Sansonetti Danielle, Nicks Rebecca J, Unsworth Carolyn
Acquired Brain Injury Rehabilitation Centre, Caulfield Hospital, Melbourne, Victoria, Australia.
Occupational Therapy Department, Alfred Health, Melbourne, Victoria, Australia.
Aust Occup Ther J. 2018 Dec;65(6):512-522. doi: 10.1111/1440-1630.12492. Epub 2018 Jun 19.
BACKGROUND/AIM: Life roles are integral to occupational therapy practice. Goal setting is a method of establishing priorities to measure outcomes. While acquired brain injury can impact a person's ability to fulfil meaningful life roles, the alignment of goals set in rehabilitation to life roles, is unclear. This study aimed to (i) explore the alignment of goals with life roles for people with an acquired brain injury participating in inpatient rehabilitation; and (ii) identify barriers and enablers to life role discussions within a patient-directed goal setting framework.
A mixed-methods study was conducted on an inpatient rehabilitation unit in Victoria, Australia. Quantitative data were obtained from a retrospective file audit of randomly selected medical records. Qualitative data were collected through: a) interviews with patients and their families; and b) A focus group with occupational therapists. Thematic analysis of both audit data and narrative data was undertaken.
Thirty files were examined and demonstrated 33% alignment between goals and life roles. Four interviews were completed with patients, with a family member participating in two of these. Themes identified were: readiness, role concept, recovery concept and goal review. Five therapists attended the focus group. Themes identified were: Patient factors, goal review, expectations, role change and environment. Interview and focus group data identified that barriers to life role discussions included: lack of patient and family readiness, patients' difficulty understanding role concept, focus on impairments and lack of family/ significant others support. Enablers included: having early conversations involving family, regular goal review and use of standardised tools.
Goal setting in alignment with life roles is important in acquired brain injury rehabilitation, but may be limited. This process can be enhanced by including patients and their significant others in early goal setting conversations, along with regular goal review across the rehabilitation process.
背景/目的：生活角色是职业治疗实践不可或缺的一部分。目标设定是一种确定优先事项以衡量结果的方法。虽然后天性脑损伤会影响一个人履行有意义生活角色的能力，但康复中设定的目标与生活角色的一致性尚不清楚。本研究旨在：（i）探讨参与住院康复的后天性脑损伤患者的目标与生活角色的一致性；（ii）在以患者为导向的目标设定框架内确定生活角色讨论的障碍和促进因素。
在澳大利亚维多利亚州的一个住院康复单元进行了一项混合方法研究。定量数据来自对随机选择的病历进行的回顾性档案审核。定性数据通过以下方式收集：a）对患者及其家属进行访谈；b）与职业治疗师进行焦点小组讨论。对审核数据和叙述性数据都进行了主题分析。
检查了30份档案，结果表明目标与生活角色之间的一致性为33%。对4名患者进行了访谈，其中2名患者有家属参与。确定的主题有：准备情况、角色概念、康复概念和目标回顾。5名治疗师参加了焦点小组讨论。确定的主题有：患者因素、目标回顾、期望、角色变化和环境。访谈和焦点小组数据表明，生活角色讨论的障碍包括：患者及其家属未做好准备、患者难以理解角色概念、关注损伤以及缺乏家人/重要他人的支持。促进因素包括：早期与家人进行沟通、定期进行目标回顾以及使用标准化工具。
在后天性脑损伤康复中，与生活角色一致的目标设定很重要，但可能存在局限性。通过让患者及其重要他人参与早期目标设定对话，以及在整个康复过程中定期进行目标回顾，可以加强这一过程。
