Zielfestlegungen in der stationären somatischen Rehabilitation--die Herausforderung bleibt

OBJECTIVE: This study aims to depict the significance of individual goal-setting in present-state medical rehabilitation. Marked discrepancies between goals of rehabilitation patients and doctors have been reported. Also, results of quality assurance programmes point to problems in goal-setting in rehabilitation.

METHODS: As part of a mixed-methods study, open guided interviews were conducted in four rehabilitation clinics with forty patients in the final stage of their 3-week stay. Two of the clinics focussed on care of cardiac patients, two others on musculoskeletal patients. Clinics were selected because of above- or below-average ratings on patients' reports in rehabilitation quality assurance of the German Pension Fund on the "rehab planning and rehab goals" scale. Content-analysis of interviews was based on a thematic coding approach. In addition, staff was invited in every clinic to join a group discussion to give feedback on the results of patient interviews.

RESULTS: All interviewees showed marked difficulties in talking about personal goals, goals of rehabilitation or even about their expectations, independent of being in a clinic rated above or below average. They enter the clinic partly without expectations or disclose global, unrealistic, or unspecific expectations. Specified goals were at best embryonic in individual patients. Expectations were primarily concerned with somatic or physical-functioning dimensions. Discussions with staff members disclosed absence of consistent views regarding goal-orientation in the respective clinics. Problems in goal-setting were both related to patients and to staff, their interaction as well as the general framework or the organisational processes within rehabilitation.

CONCLUSIONS: The significance of individual goal-setting as the "essence of rehabilitation" is not reflected in present-state rehabilitation in Germany. Starting points for change are found on different levels: patients, staff, development of organisational mission statements within the clinics, but also in changing organisational processes that appear to be dominated by economic directives.