Setting Higher Goals May Make Athletes Feel Worse: The Goal Setting Paradox and Potential Solutions

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Background: Anterior cruciate ligament (ACL) injuries are a common injury that occurs in both the sporting and non-sporting population. Goal setting is said to be an effective psychological tool within ACL rehabilitation and is commonly used by physiotherapists. To date, literature surrounding goal setting practices is under analysed in relation to qualitative research. Purpose:The central aim of this study was to explore UK physiotherapists understanding, experiences and training towards goal setting practices used in ACL rehabilitation and whether they are effective.Method: Semi-structured interviews involving 24 participants across three specific areas including: National Health Service, elite sport and academia were conducted using an inductive approach. Data analysis included thematic analysis with triangulation and a comprehensive multi-staged analysis process to enhance trustworthiness, whilst respecting ethical considerations.Results/Discussion: Participants from all three areas of practice tended to use the same approach which was SMART goals. All participants lacked any theoretical understanding of goals but would welcome further training in the field. Participants were missing important aspects of setting goals such as not addressing expectations and underutilising feedback. Conclusion:These findings suggest that a call for more psychological training is clearly warranted in both the physiotherapy curriculum and within post graduate CPD training. Creating a specialist interest group (e.g. physiotherapists interested in psychology) may help share good psychological practices and overall enhance understanding in this field.

Section: Main Findingsmentioning

confidence: 60%

Goal setting practices used within anterior cruciate ligament rehabilitation: An exploration of physiotherapists understanding, training and experiences

Alexanders

Perry²,

Douglas

2021

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“…Another significant grouping analysed the use of goal setting in post‐surgical rehabilitation, although the surgeries involved were diverse (22%). The remaining papers included very specific populations, for example, specific age groups (Blackburn & Kaplan, 2019) or contexts (Alexanders et al., 2019). These populations are summarised and further detailed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The articles found included 25 quantitative studies (61%), 13 qualitative pieces of work (32%), one mixed methods study (Schonstein et al, 2002), a narrative review (Schmidt, 2016) and an editorial GAYTON and MONGA (Alexanders et al, 2019). Notably, no systematic reviews, quantitative or qualitative, were identified.…”

Section: Study Typesmentioning

confidence: 99%

“…One of the notable findings of this study is that there is only fleeting consideration given to the various types of goals discussed in the broader literature. This is important as the failure to distinguish between different goal setting approaches may be one reason behind mixed findings in empirical studies (Swann et al, 2021) , 2004;Åsenlof et al, 2005a;Åsenlof et al, 2005b;Åsenlof et al, 2009;Emilson et al, 2017;Gustavsson and von Koch, 2022 Patient-specific complaint instrument Stevens et al, 2017 Patient specific functional scale Gardner et al, 2015;Schmidt, 2016;Gustavsson and von Koch, 2022 Physical activity tracking device Christiansen et al, 2018SMART Mannion et al, 2010Schoeb et al, 2014;Gardner et al, 2015;Gardner et al, 2016;Schmidt, 2016;Gardner et al, 2018;Alexanders et al, 2018;Gardner et al, 2019;Alexanders et al, 2019;Alexanders, Chesterton, et al, 2021;Alexanders et al, 2021b performance and learning goals (Locke & Latham, 2013), consideration of these different goal types is absent from the musculoskeletal literature. The study included by Gardner et al (2018) also highlights that this lack of clarity is common in clinical practice as well as in research.…”

Section: Gaps In the Existing Literaturementioning

confidence: 99%

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Goal setting in physiotherapy‐led adult musculoskeletal care: A scoping review

Gayton,

Monga

2023

IntroductionGoal setting is a key part of rehabilitation across various fields of physiotherapy. It is less clear what evidence exists to underpin its effectiveness and to practically guide its use within musculoskeletal physiotherapy.ObjectivesThis scoping review provides an overview of current research regarding goal setting in adult physiotherapy‐led musculoskeletal care with three aims: 1) to identify and analyse any gaps in the literature, 2) to identify relevant features of goal setting theory and 3) to make recommendations for future research. The principal research question was what does the literature tell us about the role of goal setting for adults over the age of 18 with musculoskeletal pain accessing outpatient physiotherapy services?Inclusion CriteriaThe population, concept and context framework was used to define the inclusion criteria. Key definitions were adults over the age of 18 with musculoskeletal conditions, goal setting, and physiotherapy‐led interventions.MethodsThis scoping review followed the guidance set out by the Joanna Briggs Institute Manual for Evidence Synthesis. Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, MEDLINE, American Psychological Association PsycInfo and the Cochrane Database of Systematic Reviews, Protocols and Trials were searched using pre‐defined search criteria. Data were extracted from screened full‐text articles and presented in basic statistical and narrative form.Results41 articles were included in the review. Several broad themes and research methods were identified. The nature of the studies suggested that the clinical application of goal setting is complex and the depth of understanding is limited. Most studies suggested that goal setting is feasible and has a positive impact on outcomes. A common finding was a lack of clear definitions regarding goal setting terminology and approaches. Study samples were generally defined by biomedical categories, suggesting a pathoanatomical approach to researching a cognitive construct. Theoretical underpinning was lacking in many studies. No frameworks guiding goal setting in physiotherapy‐led musculoskeletal rehabilitation have been identified.ConclusionsGoal setting is a popular tool within musculoskeletal outpatient physiotherapy. Further research is required to clarify its efficacy and provide guidance on its role and application in clinical practice.

“…Goal setting is a complex motivational tool which is underpinned by theory and can be implemented in a variety of ways such as Specific, Measurable, Achievable and Time oriented (SMART) process and performance goals (Alexanders, Kaye, & Perry, 2019). Goal setting is the most common psychological intervention utilised by physiotherapists and other sport personnel (Heaney, Green, Rostron, & Walker, 2012; Zakrajsek, Fisher, & Martin, 2017).…”

Section: Introductionmentioning

confidence: 99%

An exploration of UK student physiotherapists' goal setting practices within anterior cruciate ligament rehabilitation

Alexanders

Chesterton

Brooks

et al. 2020

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Background Anterior cruciate ligament (ACL) injuries are a common and complex injury coupled with a lengthy rehabilitation. Goal setting is said to be an effective psychological tool within ACL rehabilitation due to its simplicity and is commonly used amongst sport and health professionals. To date, literature surrounding goal setting practices has only focused on qualified therapists. Purpose The central aim of this study was to explore UK student physiotherapists' perceptions towards goal setting practices used in ACL rehabilitation and whether they feel prepared for practice. Method Semi‐structured interviews involving 11 participants from one UK university was conducted using an inductive approach. Data analysis included thematic analysis with triangulation and a comprehensive five‐stage analysis process to enhance confirmability and credibility, whilst respecting ethical considerations. Results/Discussion Participants reported some understanding of goal setting and the importance of involving the patient during this process. However, participants negatively experienced goal setting practices as being mainly therapist/protocol led. The training participants received on goal setting was minimal, but further training was welcomed by all participants. The findings were consistent with previous UK and international research surrounding inadequate education and training across sport and health professionals when applying goal setting practice within ACL rehabilitation. Conclusion These findings suggest that, initially, a review of the psychological content of sport and health professional courses is warranted to clearly identify potential knowledge gaps. There is also an opportunity whereby a global specialist interest group could be designed to share psychological practices and globally connect like‐minded sport and health professionals together.