한국전문물리치료학회지 (Physical Therapy Korea)

  • 제25권1호
  • /
  • Pages.31-38
  • /
  • 2018
  • /
  • 1225-8962(pISSN)
  • /
  • 2287-982X(eISSN)
한국전문물리치료학회 (Korean Research Society of Physical Therapy)
권호 표지
DOI QR코드

DOI QR Code

환자중심 목표설정이 아급성기 뇌졸중 환자의 재활치료 성과에 미치는 영향

The Effect of Patient-Centered Goal Setting on Rehabilitation Outcomes in Patients With Subacute Stroke

  • 원종임 (전주대학교 의과학대학 물리치료학과) ;
  • 안창만 (전북대학교병원 물리치료실) ;
  • 박민희 ((주)호연메디컬 임상교육팀)
  • Won, Jong-im (Department of Physical Therapy, College of Medical Science, Jeonju University) ;
  • An, Chang-man (Department of Physical Therapy, Chonbuk National University Hospital) ;
  • Park, Min-hee (Department of Clinical Education, Hoyeon Medical Corporation)
  • 투고 : 2017.11.12
  • 심사 : 2018.01.02
  • 발행 : 2018.02.19
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Patient-centered care has recently become highly recommended, because it can improve health outcomes more effectively than problem-oriented care. The goal attainment scale (GAS) is one of the methods used for patient-centered care. It was originally developed as an outcome measurement tool, but it can also be used as a therapeutic intervention when setting quantifiable patient-centered goals. Objects: We sought to identify the effect of setting patient-centered goals on rehabilitation outcomes in patients with subacute stoke using GAS. Methods: Overall, 46 subjects with subacute stroke were divided into experimental ($n_1=23$) and control ($n_2=23$) groups. Subjects in both groups attended physical therapy sessions five times a week for four weeks. Those in the experimental group set goals using goal-attainment scaling. The mobility of each subject was evaluated using the Rivermead mobility index (RMI); daily-living activities, using the K-modified Barthel index (K-MBI); participation, using the Hopkins rehabilitation-engagement rating scale (HRERS); satisfaction, using the patient-satisfaction scale (PSS). Results: Subjects in the experimental group experienced more significant increases in RMI, HRERS, and PSS than those in the control group (p<.05, p<.05 and p<.01, respectively). After four weeks, GAS scores of the experimental group had increased more significantly than those of baseline (p<.01). Conclusion: Setting patient-centered goals is effective in improving the mobility and satisfaction of patients with subacute stoke. Setting patient-centered goals needs to be performed more frequently in clinical settings.

키워드

참고문헌

  1. Bouwens SF, van Heugten CM, Verhey FR. Review of goal attainment scaling as a useful outcome measure in psychogeriatric patients with cognitive disorders. Dement Geriatr Cogn Disord. 2008;26(6):528-540. https://doi.org/10.1159/000178757
  2. Bovend'Eerdt TJ, Botell RE, Wade DT. Writing SMART rehabilitation goals and achieving goal attainment scaling: A practical guide. Clin Rehabil. 2009;23(4):352-361. https://doi.org/10.1177/0269215508101741
  3. Bovend'Eerdt TJ, Dawes H, Izadi H, et al. Agreement between two different scoring procedures for goal attainment scaling is low. J Rehabil Med. 2011;43(1):46-49. https://doi.org/10.2340/16501977-0624
  4. Carroll JG. In the "medical home" adult primary care setting, practitioners are seeing an increasing emphasis on patient involvement in setting the goals of care. Qual Manag Health Care. 2011;20(2):87-88. https://doi.org/10.1097/QMH.0b013e318215d488
  5. Cott CA. Client-centered rehabilitation: What is it and how do we measure it? Physiotherapy. 2008;94:89-90. https://doi.org/10.1016/j.physio.2008.02.004
  6. Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. BMJ. 2007;335(7609):24-27. https://doi.org/10.1136/bmj.39246.581169.80
  7. Grant M, Ponsford J. Goal Attainment Scaling in brain injury rehabilitaation: Strengths, limitations and recommendations for future applications. Neuropsychol Rehabil. 2014;24(5):661-677. https://doi.org/10.1080/09602011.2014.901228
  8. Holliday RC, Antoun M, Playford ED. A survey of goal-setting methods used in rehabilitation. Neurorehabil Neural Repair. 2005;19(3):227-231. https://doi.org/10.1177/1545968305279206
  9. Hsueh IP, Wang CH, Sheu CF, et al. Comparison of psychometric properties of three mobility measures for patients with stroke. Stroke. 2003;34(7):1741-1745. https://doi.org/10.1161/01.STR.0000075295.45185.D4
  10. Hurn J, Kneebone I, Cropley M. Goal setting as an outcome measure: A systematic review. Clin Rehabil. 2006;20(9):756-772. https://doi.org/10.1177/0269215506070793
  11. Khan F, Pallant JF, Turner-Stokes L. Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis. Arch Phys Med Rehabil. 2008;89(4):652-659. https://doi.org/10.1016/j.apmr.2007.09.049
  12. Kortte KB, Falk LD, Castillo RC, et al. The Hopkins Rehabilitation Engagement Rating Scale: Development and psychometric properties. Arch Phys Med Rehabil. 2007;88(7):877-844. https://doi.org/10.1016/j.apmr.2007.03.030
  13. Krasny-Pacini A, Hiebel J, Pauly F, et al. Goal attainment scaling in rehabilitation: A literature-based update. Ann Phys Rehabil Med. 2013;56(3):212-230. https://doi.org/10.1016/j.rehab.2013.02.002
  14. Kristensen HK, Tistad M, Koch Lv, et al. The Importance of Patient Involvement in Stroke Rehabilitation. PLoS One. 2016;11(6):e0157149. https://doi.org/10.1371/journal.pone.0157149
  15. Lenze EJ, Munin MC, Quear T, et al. Significance of poor patient participation in physical and occupational therapy for functional outcome and length of stay. Arch Phys Med Rehabil. 2004;85(10):1599-1601. https://doi.org/10.1016/j.apmr.2004.03.027
  16. Levack WM, Weatherall M, Hay-Smith EJ, et al. Goal setting and strategies to enhance goal pursuit for adult with acquired disability participating in rehabilitation. Cochrane Database Syst Rev. 2015;20(7):CD009727. https://doi.org/10.1002/14651858.CD009727.pub2
  17. Lewin SA, Skea ZC, Entwistle V, et al. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev. 2001;(4):CD003267.
  18. Locke, EA Latham CP. Building a practically useful theory of goal setting and task motivation. A 35-year odyssey. Am Psychol. 2002;57(9):705-717. https://doi.org/10.1037/0003-066X.57.9.705
  19. Luker J, Lynch E, Bernhardsson S, et al. Stroke survivors' experiences of physical rehabilitation: A systematic review of qualitative studies. Arch Phys Med Rehabil. 2015;96:1698-1708. https://doi.org/10.1016/j.apmr.2015.03.017
  20. Monnin D, Perneger TV. Scale to measure patient satisfaction with physical therapy. Phys Ther. 2002;82(7):682-691.
  21. Ottenbacher KJ, Cusick A. Goal attainment scaling as a method of clinical service evaluation. Am J Occup Ther. 1990;44(6):519-525. https://doi.org/10.5014/ajot.44.6.519
  22. Reid A, Chesson R. Goal attainment scaling: Is it appropriate for stroke patients and their physiotherapists? Physiotherapy. 1998;84(3):136-144. https://doi.org/10.1016/S0031-9406(05)66518-2
  23. Reuben DB, Tinetti ME. Goal-oriented patient care-An alternative health outcomes paradigm. N Engl J Med. 2012;366(9):777-779. https://doi.org/10.1056/NEJMp1113631
  24. Rockwood K, Howlett S, Stadnyk K, et al. Responsiveness of goal attainment scaling in a randomized controlled trial of comprehensive geriatric assessment. J Clin Epidemiol. 2003;56(8):736-743. https://doi.org/10.1016/S0895-4356(03)00132-X
  25. Schulman-Green DJ, Naik AD, Bradley EH, et al. Goal setting as a shared decision making strategy among clinicians and their older patients. Patient Educ Couns. 2006;63(1-2):145-151. https://doi.org/10.1016/j.pec.2005.09.010
  26. Steenbeek D, Gorter JW, Ketelaar M, et al. Responsiveness of Goal Attainment Scaling in comparison to two standardized measures in outcome evaluation of children with cerebral palsy. Clin Rehabil. 2011;25(12):1128-1139. https://doi.org/10.1177/0269215511407220
  27. Sumsion T, Law M. A review of evidence on the conceptual elements informing client-centred practice. Can J Occup Ther. 2006;73(3):153-162. https://doi.org/10.1177/000841740607300303
  28. Toto PE, Skidmore ER, Terhorst L, et al. Goal attainment scaling(GAS) in geriatric primary care: A feasibility study. Arch Gerontol Geriatr. 2015;60:16-21. https://doi.org/10.1016/j.archger.2014.10.022
  29. Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: A practical guide. Clin Rehabil. 2009;23(4):362-370. https://doi.org/10.1177/0269215508101742
  30. Turner-Stokes L, Williams H. Goal attainment scaling: A direct comparison of alternative rating methods. Clin Rehabil. 2010;24(1):66-73. https://doi.org/10.1177/0269215509343846
  31. Webb PM, Glueckauf RL. The effects of direct involvement in goal setting on rehabilitation outcome for persons with traumatic brain injuries. Rehabil Psychology. 1994;39(3):179-188. https://doi.org/10.1037/h0080321
  32. Wressle E, Eeg-Olofsson AM, Marcusson J, et al. Improved client participation in the rehabilitation process using a client-centred goal formulation structure. J Rehabil Med. 2002;34(1):5-11. https://doi.org/10.1080/165019702317242640