Communication during goal-setting in physiotherapy treatment sessions

Objective: To analyse in detail therapists' and patients' communication practices during physiotherapy goal-setting in stroke rehabilitation settings. To deduce explanations for observed practices. To contribute to understanding of the communication challenges entailed in goal-setting. Design: A conversation analytic study of video-recorded treatment sessions. Setting: Physiotherapy ‘gyms’ in four UK hospitals. Subjects: The 74 recorded sessions involved 21 patients (52-86 years, 11 female) and 10 senior physiotherapists. Patients' disabilities varied; none were severely aphasic. Nine of the therapists were female, post qualification experience ranged from 3 to 23 years. Findings: Eight goal-setting episodes were identified. In all but one, therapists supplied the target problems or abilities for which goals were subsequently set. The case in which the patient was asked to propose problems prior to goal-setting is examined in detail. Various interactional difficulties and delays arose both in eliciting the patient's views and incorporating them into agreed goals. Strategies by which the therapist dealt with difficulties included repeated and constraining questions, negotiation, and amending proposed goals. Conclusions: Findings of this small, detailed study might help explain previous observations of infrequent goal-setting and failure to maximize patients' involvement therein. Goal-setting, particularly where patients' views are elicited and incorporated, involves skill and effort, and is influenced by powerful social constraints. Developing detailed knowledge of both practices and constraints may contribute to improving professional practice, guidance and education. The paper demonstrates the utility of detailed analysis of rehabilitation communication using conversation analytic methods.