Goals Set and Goals Met: Toward Demystifying Expectations and Outcomes during In-Patient Rehabilitation

Goal-setting is an essential component of rehabilitation practice yet limited evidence exists about the contributing factors and effectiveness. We retrospectively analyzed Functional Independence Measure (FIM) data, an 18-item burden of care instrument, from 3,441 patients admitted to our rehabilitation center. The aim was to compare FIM scores (range 1-7) for the goals set on admission with FIM scores on admission and discharge, and determine the impact of diagnostic groups, socio-demographic status, and medical complexity.

Higher average goals (≥1.5 admission scores) were set for mobility, lower body dressing, and bladder management. Lower average goals (≤1.0) were set for eating, climbing stairs, and cognitive items. Logistic regression models, controlling for severity of disability, found that significantly (p<0.05) higher goals were set for younger patients and those with brain and spinal cord injuries, whereas lower goals (p<0.01) were set for stroke and medically complicated patients. At discharge, 68% of patients achieved >15 goals but 9% <9 goals. Goal-attainment was higher for cognitive items, eating, and climbing stairs, and lower for sphincter management and tub transfer. Significantly (p<0.001) higher prevalence of meeting/exceeding goals was found for younger and orthopedic patients, whereas stroke and medically complicated patients less likely achieved set goals.

Our preliminary results indicate discrepancies between goals set and admission status across functional independence activities and identify age and diagnosis as contributing factors. Predictably, the expectation set on admission are inversely related to the goals met at discharge, however, the goal attainment is strongly influenced by age, diagnosis, and medical complexity of patients.