Goal setting for people with mild cognitive impairment or dementia in rehabilitation: A scoping review

Abstract

Introduction Goal setting is an integral part of the rehabilitation process and assists occupational therapists to target therapy towards achieving meaningful outcomes. People with mild cognitive impairment or dementia may experience barriers participating in goal setting due to preconceptions that the person cannot participate owing to changes in both cognitive and communicative abilities. The aim of this review was to identify goal setting approaches, common goals identified, and enablers and barriers to goal setting for people with mild cognitive impairment or dementia participating in specific rehabilitation programmes. Methods Four electronic databases were searched in April 2020 for English language articles that described goal setting processes during a rehabilitation programme for people with mild cognitive impairment or dementia. Studies of all designs were included. Two authors screened citations and full text articles. Data were extracted, synthesised, and presented narratively. Results Twenty‐seven studies met the eligibility criteria. Both structured and nonstructured goal setting methods were used with common tools including the Canadian Occupational Performance Measure, the Bangor Goal Setting Interview and Goal Attainment Scaling. The nature of goals tended to depend on the scope of the rehabilitation programme in which the person was involved. Goal setting was more difficult for people with more advanced symptoms of dementia and when staff lacked skills and experience working with people with dementia. Use of a structured approach to goal setting, establishment of therapeutic rapport, individualisation of goals, and family involvement were reported to be beneficial. Conclusion Collaborative goal setting is a foundation of rehabilitation for people with dementia and should not be avoided due to preconceptions that the person cannot participate. Results suggests that occupational therapists can use a number of strategies to maximise participation and engagement and play a pivotal role in upskilling staff to enable effective goal setting for people with mild cognitive impairment or dementia.

Suitability of Goal Attainment Scaling in Older Adult Populations with Neurodegenerative Disease Experiencing Cognitive Impairment: A Systematic Review and Meta-Analysis

“…This suggests that across older adult populations with neurodegenerative disease experiencing dementia or cognitive impairment, GAS may be able to detect clinically meaningful change and may be responsive to measuring progress toward functional patient-centered goals related to communication, cognition, QOL, or ADLs. These findings are consistent with other systematic reviews suggesting that GAS is responsive to functional change in geriatric rehabilitation [8, 20] and in adults with cognitive impairment [23]. While these reviews did not specifically evaluate GAS in older adults with neurodegenerative disease experiencing dementia or cognitive impairment, responsiveness trends are similar between this study and the studies mentioned above (i.e., statistically significant pre- and post-intervention GAS scores).…”

“…No other studies reported metrics for reliability or validity. This is consistent with other systematic and scoping reviews that have found sparse reporting on the validity and reliability of GAS use in rehabilitation research [33] and in adults with communication disorders [9], MCI, or dementia [8]. One systematic review of GAS use in geriatric rehabilitation [20] found that GAS showed high concurrent, content, and predictive validity, as well as high inter-rater reliability.…”

Characteristics of goal-setting tools in adult rehabilitation: A scoping review

“…Six of the identified tools were described and studied in five or more articles. These included Goal Attainment Scaling including Goal Attainment Scaling for Major Depressive Disorder and Goal Attainment Scaling for Upper Limb Spasticity 28–57,113,114,118–143,150,172,181 ( n = 61), Canadian Occupational Performance Measure 6,25–27,101,103…”

“…Only five of the identified tools made use of information and communications technology for goal setting, four of which were categorized as tools for goal selection and goal documentation. These included Canadian Occupational Performance Measure, 6,25–27,101,103–114,142,171,175,176 Goal Attainment Scaling, 28–57,113,114,118<...…”

“…Six of the identified tools were described and studied in five or more articles. These included Goal Attainment Scaling including Goal Attainment Scaling for Major Depressive Disorder and Goal Attainment Scaling for Upper Limb Spasticity 28-57, 113,114,118-143,150,172,181 (n = 61), Canadian Occupational Performance Measure 6,[25][26][27]101,[103][104][105][106][107][108][109][110][111][112][113][114]142,171,175,176 (n = 21), Goal Management Training [77][78][79][80][81][82][83][84][85][86][144][145][146] (n = 13), International Classification of Functioning, Disability and Health 6,[22][23][24]138,149,[153][154][155][156][157] (n = 11) and the Goal setting and Action Planning…”