Is achievement of short-term goals a valid measure of patient progress in inpatient neurological rehabilitation?

Abstract

Objective: To determine whether the use of short-term goal setting is effective in monitoring patient progress, with regard to achievement of rehabilitation goals for discharge and predicted length of hospital stay. Design: A prospective observational cohort study. Setting: An inpatient rehabilitation unit co-located with a large tertiary teaching hospital. Subjects: Consecutive cases admitted to rehabilitation with a neurological condition and a planned length of stay of three weeks or longer. Procedure: Discharge and short-term goals and predicted length were set in the initial team meeting. Goals were set, and achievement scored, in the domains of health, social functioning, communication and cognition, mobility and activities of daily living (ADLs) and a composite goal of global function. Actual length of stay and discharge destination were recorded. Results: Data from 53 consecutive cases were examined, with 45 cases returning home. The median length of stay was 49 days (interquartile (IQ) 30—74). Significant correlations (P<0.05) were demonstrated between short-term goal achievement and discharge goals for continence (ρ = 0.62), transfers (ρ = 0.53), personal activities of daily living (ρ = 0.47) and global function (ρ = 0.62). For those that returned home, there were significant correlations (P<0.05) between adherence to predicted length of stay and achieving their initial goals in transfers (ρ = 0.44), walking (ρ = 0.51) and global function (ρ = 0.55). Conclusion: Short-term goal setting is a valid measure of patient progress in inpatient neurological rehabilitation and can be used to identify patients who are not progressing as anticipated, facilitating review of the rehabilitation plan.