title: Goal setting and strategies to enhance goal pursuit in adult rehabilitation: summary of a Cochrane systematic review and meta-analysis.
abstract: BACKGROUND
  Goal setting is considered an essential part of rehabilitation, but approaches to goal setting vary with no consensus regarding the best approach. The aim of this systematic review and meta-analysis was to assess the effects of goal setting and strategies to enhance the pursuit of goals on improving outcomes in adult rehabilitation.
  
  
  METHODS
  We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trial registries for randomized control trials (RCTs), cluster RCTs, or quasi-RCTs published before December 2013. Two reviewers independently screened all search results, then critically appraised and extracted data on all included studies. We identified 39 trials, which differed in clinical context, participant populations, research question related to goal use, and outcomes measured. Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting.
  
  
  RESULTS
  These 18 studies provided very low-quality evidence for a moderate effect size that any type of goal setting is better than no goal setting for improving health-related quality of life or self-reported emotional status (N.=446, standard mean difference [SMD]=0.53, 95% confidence interval [CI]: 0.17 to 0.88), and very low-quality evidence of a large effect size for self-efficacy (N.=108, SMD=1.07, 95% CI: 0.64 to 1.49). Fourteen studies compared a structured approach to goal setting to "usual care" goal setting, where some goals may have been set but no structured approach was followed. These studies provided very low-quality evidence for a small effect size that more structured goal setting results in higher patient self-efficacy (N.=134, SMD=0.37, 95% CI: 0.02 to 0.71). No conclusive evidence was found to support the notion that goal setting, or structured goal setting in comparison to "usual care" goal setting, changes outcomes for patients for measures of participation, activity, or engagement in rehabilitation programs.
  
  
  CONCLUSIONS
  This review found a large and increasing amount of research being conducted on goal setting in rehabilitation. However, problems with study design and diversity in methods used means the quality of evidence to support estimated effect sizes is poor. Further research is highly likely to change reported estimates of effect size arising from goal setting in rehabilitation.
authors.affiliation: Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand - william.levack@otago.ac.nz.
authors.forename: William M
authors.initials: WM
authors.lastname: Levack
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
authors.forename: Jean C
authors.initials: JC
authors.lastname: Hay-Smith
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Dean
authors.forename: Kath
authors.initials: K
authors.lastname: McPherson
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Siegert
mesh_terms: D015982:Bias; D006040:Goals; D006801:Humans; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D018802:Patient-Centered Care; D012046:Rehabilitation / Q000523:psychology*