Development and evaluation of a training module on the  Collaborative Goal Setting  in inpatient medical rehabilitation (ParZivaR)

Collaborative goal setting constitutes an important component of rehabilitation. However, various investigations indicate that there is potential for improvement in terms of goal setting. For instance, rehabilitees frequently do not know which concrete goals should even be pursued in rehabilitation. Therefore, the aim of this project was to initially examine how goal setting is conducted in the cooperating rehabilitation centers. Based on this, in a second step, an intervention for improving the quality of collaborative goal setting was developed. The core of the intervention was to involve rehabilitees more strongly in the goal setting process. The intervention aimed at rehabilitees with chronic back pain or coronary heart disease and was implemented in two inpatient rehabilitation centers. The results of the intervention evaluation, in which the data of N = 452 rehabilitees were entered, show that in both diagnostic groups, the intervention has the potential to improve proximal outcome variables. For instance, goal-related aspects which are defined in the literature as quality criteria of goal setting are more frequently evaluated by the rehabilitees as present after the intervention has been implemented than beforehand. By contrast, with regard to "distal" outcome parameters, i.e. those that are less closely related to the intervention, the formulated hypotheses could not be proven to a great extent. For example, the quality of physician-patient interaction was not better evaluated after the intervention had been implemented than beforehand. The survey of the treatment providers regarding the intervention showed, moreover, that there is potential for improvement with regard to the transfer of the intervention to everyday care practice. For the actual utilisation of the available concept in the centers, on the one hand, sufficient time resources are essential. Moreover, greater considerations are necessary with regard to how a benefit of the intervention for the providers can become discernible to a greater extent and how the developed intervention might be adapted to this aim. These questions demonstrate a need for future research.

The project was conducted in a cooperation between the department of Quality Management and Social Medicine (AQMS, Prof. Dr. W. H. Jäckel) at the University Medical Center Freiburg and the Institute for Rehabilitation Research (IfR) at the Klinik Münsterland, Bad Rothenfelde (Prof. Dr. B. Greitemann).

Project results have been reported at the following congresses:

• Dibbelt S: Parzivar: An Intervention Towards "Smart" Shared Goals in Rehabilitation for Patients with Chronic Low Back Pain. 13th ISPO World Congress and ORTHOPAEDIE + REHA-TECHNIK 2010 in Leipzig
• Dibbelt S, Dudeck A, Glattacker M, Quatmann M, Greitemann B, Jäckel WH: Parzivar - Eine Intervention zur partizipativen Vereinbarung "smarter" Ziele zwischen Arzt und RehabilitandInnen - Erste Erfahrungen. 19. Rehabilitationswissenschaftliches Kolloquium in Leipzig 2010. DRV-Schriften, 2010; 88: 231-232
• Dibbelt S, Dudeck A, Glattacker M, Greitemann B, Jäckel WH, Quatmann M: Participative goal setting: "Smart" goals of patients with chronic back pain. EACH 2010 'International Conference on Communication in Healthcare', Verona, Italy
• Dudeck A, Glattacker M, Dibbelt S, Schaidhammer-Placke M, Jäckel WH: Participative goal setting in medical rehabilitation: importance of the team. Abstract Book 5th ISPRM World Congress, 2009: 145-145
• Dudeck A, Glattacker M, Gustke M, Dibbelt S, Schaidhammer-Placke M, Greitemann B, Jäckel WH: Haben Patienten Reha-Ziele und wenn ja, welche? Ergebnisse einer Analyse von Freitextangaben. 18. Rehabilitationswissenschaftliches Kolloquium in Münster 2009. DRV-Schriften, 2009; 83: 49-51
• Dudeck A, Glattacker M, Gustke M, Dibbelt S, Greitemann, B, Jäckel WH: Reha-Zielvereinbarungen – Nutzen, Barrieren und Erfordernisse aus BehandlerInnensicht. 19. Rehabilitationswissenschaftliches Kolloquium in Leipzig 2010. DRV-Schriften, 2010; 88: 233-235
• Dudeck A, Glattacker M, Gustke M, Dibbelt S, Greitemann B, Jäckel WH: Individuelle Rehabilitationsziele bei Koronarer Herzkrankheit in der stationären kardiologischen Rehabilitation - Rehabilitanden- und Behandlerperspektive. 9. Deutscher Kongress für Versorgungsforschung in Bonn 2010. Monitor Versorgungsforschung, 2010: 44-45
• Glattacker M, Dudeck A, Dibbelt S, Greitemann B, Jäckel WH: Die Umsetzung von Zielorientierung im Rehabilitationsprozess aus Sicht von RehabilitandInnen und BehandlerInnen. 19. Rehabilitationswissenschaftliches Kolloquium in Leipzig 2010. DRV-Schriften, 2010; 88: 211-213
• Glattacker M, Dudeck A, Dibbelt S, Quatmann M, Schubmann R, Greitemann B, Jäckel WH: Evaluation einer Intervention zur partizipativen Zielvereinbarung: Verändern sich zielbezogene Prozesse in der Wahrnehmung der RehabilitandInnen? 20. Rehabilitationswissenschaftliches Kolloquium in Bochum 2011. DRV-Schriften, 2011; 93: 159-160
• Glattacker M, Dudeck A, Dibbelt S, Schaidhammer-Placke M, Greitemann B, Jäckel WH: Partizipative Vereinbarung von Rehabilitationszielen aus Patientensicht: Wunsch und Wirklichkeit. 18. Rehabilitationswissenschaftliches Kolloquium in Münster 2009. DRV-Schriften, 2009; 83: 47-49
• Glattacker M, Dudeck A, Dibbelt S, Schaidhammer-Placke M, Greitemann B, Pollmann H, Jäckel WH: Entwicklung und Evaluation eines Trainingsmoduls zur Partizipativen Vereinbarung von Zielen in der stationären medizinischen Rehabilitation. Jahresaustausch der Deutschen Gesellschaft für Sozialmedi­zin und Prävention, DGSMP in Hannover 2008. Gesundheits­wesen, 2008; 70: 441-442
• Quatmann M, Dibbelt S, Dudeck A, Glattacker M, Greitemann B, Jäckel WH: Zielvereinbarungen in der Rehabilitation: Verständnis und Handhabung des Begriffs „Reha-Ziele" bei Ärzten und Patienten. 20. Rehabilitationswissenschaftliches Kolloquium in Bochum 2011. DRV-Schriften, 2011; 93: 161-162
• Schaidhammer M, Dibbelt S, Glattacker M, Dudeck A: Partizipative Zielvereinbarung in der Rehabilitation - Eine Intervention zur Optimierung der Kommunikation zwischen Arzt und Rehabilitand. 18. Rehabilitationswissenschaftliches Kolloquium in Münster 2009. DRV-Schriften, 2009; 83: 58-59

The following publications on the project are available:

• Dibbelt S, Quatmann M, Dudeck A, Glattacker M, Greitemann B (2011). Partizipative Zielvereinbarung zwischen Arzt und Rehabilitand. Eine Intervention zur Aushandlung "smarter" Ziele in der Rehabilitation - Ergebnisse zur Prozessevaluation aus dem PARZIVAR Projekt. Orthopädie Technik 6/11, 440-448
• Dudeck A, Glattacker M, Gustke M, Dibbelt S, Greitemann B, Jäckel WH (2011). Reha-Zielvereinbarungen – Gegenwärtige Praxis in der stationären medizinischen Rehabilitation. Rehabilitation, 50: 316-330.
• Glattacker M, Dudeck A, Gustke M, Dibbelt S, Schaidhammer-Placke M, Greitemann B, Pollmann H, Jäckel WH (2008). Zielvereinbarungen in der Rehabilitation von PatientInnen mit Diabetes mellitus. Praxis Klinische Verhaltensmedizin und Rehabilitation, 21 (82): 282-290