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Theresa Smith, Lisa Foret, Guy Davis, Robert W Massof; Factors Influencing Goal Setting in Low Vision Rehabilitation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4669.
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© ARVO (1962-2015); The Authors (2016-present)
Patient satisfaction with the outcome of low vision rehabilitation is linked to achievement of patient-identified goals. Patient and therapist perspectives frequently differ on whether or not a goal is achievable. Many of the factors affecting the therapist’s decision-making process have face validity or are supported by anecdotal evidence. The aim of this study is to elucidate factors individual therapists consider when deciding whether to include a patient-selected goal in the plan of care (POC).
An emergent mixed method study design was used. Baseline functional independence ratings (FIM scores) and expected FIM scores as a consequence of therapy were assigned by the therapist to each patient-selected goal for 45 home health care patients having low vision. Qualitative data were obtained using a survey of 11 plausible factors elicited from the therapist that influence goal setting. The 24 goals with higher probability of not being included in the POC were selected from the 50 goals of the Activity Inventory. These goals were then organized into 4 goal categories: ADLS, IADLS, Social Participation, and Leisure. The goal categories were populated with factors likely to affect goal setting. Concurrently, logistic regression analysis was performed on the therapist’s baseline and expected FIM ratings and on measures of mental and physical health for each patient-selected goal to determine how well each predicts that the goal will be included in the POC.
The goal category most likely to have patient-selected goals excluded from the POC was IADLs with Leisure a close second. Logistic regression showed that the FIM score the therapist expected the patient to be able to achieve after rehabilitation is a very strong predictor of whether or not the goal is included in the POC (other measures of patient mental and physical health state were not predictive).
From qualitative analysis, we conclude that therapists give greatest weight to ADL- and social interaction-related goals in constructing the POC and less weight to IADL- and leisure-related goals. Based on quantitative analysis of therapist’s FIM scores, we conclude that estimates of the patient’s rehabilitation potential is the strongest factor for inclusion of the goal in the POC.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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