Goal setting in Dutch paediatric rehabilitation. Are the needs and principal problems of children with cerebral palsy integrated into their rehabilitation goals?

Abstract

Objective: To evaluate whether the needs and principal problems of children with cerebral palsy (CP) as formulated in their interdisciplinary rehabilitation reports are integrated into the goal descriptions and whether this depends on the nature of the needs and problems.

Design: Descriptive multiple-case study.

Setting: Five Dutch paediatric rehabilitation facilities.

Subjects: The rehabilitation profiles of 41 children with cerebral palsy aged between 4 and 8 years.

Methods: The raw text data were extracted and organized, after which two raters independently linked the extracted content to the categories of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). Matches between needs, problems and goals were identified by ICF-CY code comparisons.

Results: The Cohen's kappas for ICF-CY encoding were all in the range of `fair to good' (0.52—0.78). For five children (12%) no needs had been formulated and the reports of 10 (24%) were excluded from further analyses as they lacked a principal goal. In the 31 reports analysed, 29 (23%) need constructs and 46 (46%) problem constructs were incorporated into the goals. Of the total of 95 goal constructs 49 (52%) were not related to either a need or a problem construct. No clear relationship could be established between the type of needs and problems and their inclusion or exclusion in the principal goals.

Conclusion: Overall, the integration of the needs and principal problems of children with their rehabilitation goals was not optimal. However, integration was difficult to objectify because needs, problems and goals were poorly documented.

Get full access to this article

View all access options for this article.

References

Bakheit AMO. Effective teamwork in rehabilitation. Int J Rehabil Res 1996; 19: 301-306.

Barnes KJ , Turner KD Team collaborative practices between teachers and occupational therapists . Am J Occup Ther 2001; 55: 83-89.

Hinojosa J. , Bedell G. , Buchholz ES , Charles J. , Shigaki IS , Bicchieri SM Team collaboration: a case study of an early intervention team. Qual Health Res 2001; 11: 206-20.

Robards MF Running a team for disabled children and their families. Mac Keith Press, 1994.

Rosen C. , Miller AC , Pit-ten-Cate IM , Bicchieri S. , Gordon RM , Daniele R. Team approaches to treating children with disabilities: a comparison . Arch Phys Med Rehabil 1998; 79: 430-34.

Thylefors I. , Price E. , Persson TO , von Wendt L. Teamwork in Swedish neuropaediatric habilitation . Child Care Health Dev 2000; 26: 515-32.

Yerbury M. Issues in multidisciplinary teamwork for children with disabilities . Child Care Health Dev 1997; 23: 77-86.

DePompei R. , Williams J. Working with families after TBI: A Family-centered approach. Top Language Disord 1994; 15: 68-81.

Hostler SL Pediatric family-centered rehabilitation. J Head Trauma Rehabil 1999; 14: 384-93.

10.

King GA , Rosenbaum PL , King SM Evaluating family-centred service using a measure of parents' perceptions . Child Care Health Dev 1997; 23: 47-62.

11.

King S. , Teplicky R. , King G. , Rosenbaum P. Family-centered service for children with cerebral palsy and their families: a review of the literature. Semin Pediatr Neurol 2004; 11: 78-86.

12.

Nijhuis BJG , Reinders-Messelink HA , Blecourt de ACE , et al. A review of salient elements defining team collaboration in paediatric rehabilitation . Clin Rehabil 2007; 21: 1-17.

13.

Rosenbaum P. , King S. , Law M. , King G. , Evans J. Family-centred service: a conceptual framework and research review. Phys Occup Ther Pediatr 1998; 18: 1-20.

14.

De Moor J. , Didden R. , Nuis M. , van de Ven G. Assessing needs for interdisciplinary team training in children's rehabilitation: a pilot study. Int J Rehabil Res 1999; 22: 93-100.

15.

Dule K. , Korner H. , Williams J. , Carter M. Delivering therapy services for students with high support needs: perceptions of roles, priorities and best practice. J Intellect Dev Disabil 1999; 24: 243-63.

16.

Fell B. , Pierce K. Meeting the ADD Challenge: a multimodal plan for parents, students, teachers, and physicians. Intervent School Clin 1995 ; 30: 198-202.

17.

Roelofsen EE , Lankhorst GJ , Bouter LM Simultaneous development and implementation of the children's rehabilitation activities profile: a communication instrument for pediatric rehabilitation. Disabil Rehabil 2001; 23: 614-22.

18.

Holliday RC , Antoun M. , Playford ED A survey of goal-setting methods used in rehabilitation. Neurorehabil Neural Repair 2005; 19: 227-31.

19.

Playford ED , Dawson L. , Limbert V. , Smith M. , Ward CD , Wells R. Goal-setting in rehabilitation: report of a workshop to explore professionals' perceptions of goal-setting. Clin Rehabil 2000; 14: 491-96.

20.

Randall KE , McEwen II Writing patient-centered functional goals. Phys Ther 2000; 80: 1197-203.

21.

Schut HA , Stam HJ Goals in rehabilitation teamwork. Disabil Rehabil 1994; 16: 223-26.

22.

Siegert RJ , Taylor W. Theoretical aspects of goal-setting and motivation in rehabilitation . Disabil Rehabil 2004; 26: 1-8.

23.

Levack WMM , Taylor K. , Siegert J. , Dean SS , McPherson KM , Weatherall M. Is goal planning in rehabilitation effective? A systematic review. Clin Rehabil 2006; 20: 739-55.

24.

Roelofsen EE , The BAM , Beckerman H. , Lankhorst GJ , Bouter LM Development and implementation of the rehabilitation activities profile for children: impact on the rehabilitation team. Clin Rehabil 2002; 16: 441-53.

25.

Nijhuis BJG , Reinders-Messelink HA , Blecourt de ACE et al. Goal setting in Dutch paediatric rehabilitation: an evaluation of needs, principal problems and principal rehabilitation goals of children with cerebral palsy . (Submitted 2007).

26.

Palisano R. , Rosenbaum P. , Walter S. , Russell D. , Wood E. , Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997 ; 39: 214-23.

27.

World Health Organization. International Classification of Functioning, Disability, and Health-Version for Children and Youth: ICF-CY . WHO Workgroup for Development of Version of ICF for Children and Youth. WHO, 2007 .

28.

World Health Organization. International Classification of Functioning, Disability, and Health (ICF). WHO, 2001.

29.

Cieza A. , Geyh S. , Chatterji S. , Kostanjsek N. , Ustun B. , Stucki G. ICF linking rules: an update based on lessons learned. J Rehabil Med 2005; 37: 212-18.

30.

Landis JR , Koch GG The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-74.

31.

Roelofsen EE The rehabilitation activities profile for children, development, implementation and evaluation. Thesis, Department of Rehabilitation Medicine, University Hospital Vrije Universiteit, 2001.

32.

Monaghan J. , Channell K. , McDowell D. , Sharma A. Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation. Clin Rehabil 2005; 19: 194-99.

33.

Rosenbaum P. , Stewart D. The World Health Organization international classification of functioning, disability and health: a model to guide clinical thinking, practice and research in the field of cerebral palsy. Semin Pediatr Neurol 2004; 11: 5-10.

34.

Siebes RC , Ketelaar M. , Gorter JW , et al. Transparency and tuning of rehabilitation care for children with cerebral palsy: a multiple case study in five children with complex needs . Dev Neurorehabil 2007 (in press).

35.

Ketelaar M. , Vermeer A. , 't Hart H. , Petegem-van Beek E. , Helders PJM. Effects of a functional therapy program on motor abilities of children with cerebral palsy . Phys Ther 2001; 81: 1534-45.

36.

Law M. , Baptiste S. , McColl M. , Opzoomer A. , Polatajko H. , Pollock A. The Canadian occupational performance measure: an outcome measure for occupational therapy. Can J Occup Ther 1990; 57: 82-87.

37.

Verkerk GJQ , Wolf Mmag , Louwers AM , Meester-Delver A. , Nollet F. The reproducibility and validity of the Canadian occupational performance measure in parents of children with disabilities. Clin Rehabil 2006 ; 20: 980-88.

38.

Kiresuk TJ , Smith A. , Cardillo JE Goal Attainment Scaling: applications, theory and measurement Lawrence Erlbaum, 1994.

39.

Kiresuk TJ , Sherman RE Goal attainment scaling, a general method for evaluating comprehensive community mental health programs. Community Mental Health J 1968; 4: 443-45.