Author: Praneeta Jogie
Jogie, Praneeta, 2023 Goal setting for people with mild cognitive impairment or dementia participating in rehabilitation programs, Flinders University, College of Medicine and Public Health
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Globally, unmet rehabilitation needs are increasing (Gimigliano & Negrini, 2017). Rehabilitation can reduce the impact of disability and improve participation in daily tasks (World Health Organisation, 2021b). Goal setting is a crucial component of the rehabilitation process; it supports the implementation of appropriate interventions (Wade, 2020b), and is typically conducted in collaboration with the patient, family and/or caregiver (Levack, Dean, Siegert, & McPherson, 2006; National Stroke Foundation, 2010; Wade, 2009). Effective goal setting between patients and health professionals can improve motivation to participate (Leach, Cornwell, Fleming, & Haines, 2010). Patients are more engaged in therapy if they are involved in their own health care decision making and have a shared understanding of reasons for rehabilitation (Leach et al., 2010; Wade, 2009).
Over the years, a considerable amount of research has been conducted on how rehabilitation services are delivered, with a strong emphasis towards adopting a person-centred approach (Santana et al., 2018). Goal setting is a means to enable person-centred care in rehabilitation and whilst a person-centred approach is viewed as essential, barriers do exist (Sugavanam, Mead, Bulley, Donaghy, & van Wijck, 2013). Cognitive and communication difficulties have been identified as key barriers to goal setting in rehabilitation (Rosewilliam, Roskell, & Pandyan, 2011; Sugavanam et al., 2013). People with mild cognitive impairment or dementia will experience changes in cognition and communication. A person-centred approach for this population may prove to be challenging. Regardless, people with mild cognitive impairment or dementia require access to rehabilitation to maintain their functional abilities and participate in daily activities (World Health Organisation, 2017). Dementia is a leading cause of disability burden in older people in Australia and is a health priority worldwide (World Health Organisation, 2017, 2021a). This thesis therefore aims to examine the scope and validity of goal setting for people with mild cognitive impairment or dementia participating in rehabilitation programs.
The first study, described in Chapter three of this thesis, is a scoping review of goal setting for people with mild cognitive impairment or dementia participating in rehabilitation programs. The purpose was to identify existing approaches to goal setting including barriers and enablers for people with mild cognitive impairment or dementia participating in rehabilitation programs. It was found that both structured and unstructured methods of goal setting are used, and that strategies to overcome cognitive and communication barriers can be used to maximise participation.
Chapter four presents findings from a quantitative study that examined whether people with mild cognitive impairment or mild severity dementia can accurately measure progress towards goals and/or report outcomes, using goal attainment scaling. A key finding was that goal attainment scaling can be used for this population.
Results of the two studies suggest that regardless of cognitive and communication difficulties, people with mild cognitive impairment or dementia can engage in goal setting using a structured approach. These findings should prompt health professionals and rehabilitation programs to adapt clinical practice. This will enable people with mild cognitive impairment or dementia to gain greater access to rehabilitation.
Keywords: Goal setting; Mild cognitive impairment, Dementia, Rehabilitation
Subject: Disability and Rehabilitation Studies thesis
Thesis type: Masters
Completed: 2023
School: College of Medicine and Public Health
Supervisor: Kate Laver