Alignment between goal-setting and personalized medical rehabilitation programs: a single-center retrospective study

Vollständiger Abstract

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INTRODUCTION. Effective medical rehabilitation is based on person-centered goal setting, which determines the logic and scope of interventions by the multidisciplinary rehabilitation team (MDRT). However, to date, it remains unknown to what extent the actually prescribed procedures of the individual medical rehabilitation program correspond to the stated rehabilitation goal, as well as what proportion of "non-target" prescriptions are made by different specialists at the second stage of rehabilitation. AIM. To examine the relationship between the goal formulated by the multidisciplinary medical rehabilitation team and the procedures prescribed within the Individual Medical Rehabilitation Program (IMRP) in patients with central nervous system disorders at the second stage of medical rehabilitation, and to determine the frequency and structure of prescriptions not related to the rehabilitation goal, stratified by each multidisciplinary rehabilitation team (MDRT) specialist. MATERIALS AND METHODS. The retrospective study included 312 patients who completed a rehabilitation course in a department for patients with central nervous system disorders. The following were analyzed: all documented rehabilitation goals (n = 312); each procedure of the IMRP (total of 2,415 prescriptions) with an assessment of its relationship to the goal (related/unrelated); the proportion of goal-unrelated prescriptions, separately for the physical rehabilitation specialist, ergorehabilitation specialist, medical speech-language pathologist, medical psychologist, and physical and rehabilitation medicine (PRM) physician. RESULTS. Of all prescribed IMRP interventions, 54.3 % were directly related to the established rehabilitation goal, whereas 45.7 % showed no such relationship. The physical rehabilitation specialist delivered goal-related interventions in 82.3 % of cases. The proportion of goal-oriented prescriptions was considerably lower among other specialists: occupational therapy specialist — 26.1 %, PRM physician — 26.2 %, medical psychologist — 25.6 %, and medical speech-language specialist — 20.7 %. Consequently, between 73.9 % and 79.3 % of prescriptions from these specialists lacked documented justification by the stated rehabilitation goal. DISCUSSION. The predominance of mobility-related goals (walking, 86.9 %) creates documented grounds for a high proportion of goal-unrelated prescriptions among specialists whose professional scope extends beyond mobility (speech therapist, medical psychologist, occupation therapist). The low proportion of goal-oriented interventions in these specialists (20.7–26.1 %) reflects not a lack of competence, but rather the narrowness of goal formulation that fails to incorporate communication, cognitive, and daily-living needs. Thus, technically sound SMART goal-setting without multidisciplinary consensus does not guarantee content validity of the rehabilitation plan. CONCLUSION. At the second stage of medical rehabilitation for patients with central nervous system disorders, a substantial disconnect has been identified between goal setting and the actual intervention program (IMRP). For several multidisciplinary rehabilitation team specialists — specifically, the medical speech-language pathologist, medical psychologist, and occupational therapy (ergorehabilitation) specialist — nearly half of all prescribed interventions are unrelated to the stated goal. These findings support the need to develop and test standardized goal-setting tools for routine clinical practice in neurorehabilitation within prospective studies.