2.1 Developing Goals & Pt Collaboration

Question 1

Overview for creating Pt-centered goals

Answer 1

1. Determine the goals
2. State to the examiners: I would collaborate and consult with your patient to determine patient-centered goals
3. State each goal and why you chose it

Question 2

1. Determine the goals

Answer 2

Short-term: 3-4, Long-term: 2-3
Goals→address the impairments in the problem list
* make explaining why you choose that goal easy!

Scan the case for any clues about the Pt’s interests or challenges

Create time-bounded goals (e.g. before DC, everyday, after each session, within 2 months)

Question 3

Short vs long-term goals

Answer 3

Short-term= within days - weeks
Long-term= within months - years/by DC, end of PT Rx

Short-term goals
* Build to get the Pt towards their long-term goal
E.g. 1: MSK injury: e.g. Acute Grd 2 ankle sprain
Short-term→acute management of the issue
- Dec. pain, inflammation
- Inc. ROM, functional use
OK: Dec. pain from 7→2 within the next 2 weeks

E.g. 2: chronic condition: e.g. MS
Short-term: diff vs MSK injury, longer timeline
- Inc. safety of transfer within the next month
E.g. Paresthesia→not realistic in 1 week, within next 2 months ok

Long-term goals
Focus on:
- MSK: what the Pt wants to achieve by the end of treatment
- Chronic condition: the Pt’s main reason for attending PT
think: What is this Pt trying to achieve by coming to PT?

E.g. 1: MSK: knee injury playing a sport
- Return to sport→determine appropriate timeline (based on Pt injury)

E.g. 2: MS: struggle to ambulate longer distance due to fatigue
- Increase ambulation distance→provide a generally realistic timeline to achieve (e.g. 6 months)

Question 4

2. How could you promote patient collaboration while developing goals?

Answer 4

• Actively listen during the subjective examination to ensure the Pt’s concerns are being heard
• Provide clear explanations of assessment findings so the Pt is able to make informed decisions about their care
• Provide clear explanations of the role of PT so the Pt is aware of how the PT can help manage their condition/injury
• Ask the Pt what they would like to achieve through PT intervention

Question 5

2. What is patient-centered goals?

Answer 5

Working with the Pt to make short or long-term goals that meet the needs of the Pt and are meaningful to the Pt

Question 6

Case example’s problem list:
1. Dyspnea
2. Decrease mobility status
3. Currently smoking
4. Presence of secretions
5. Co-morbidities: hypertension and type 2 diabetes

Goals for each of them

Answer 6

Dyspnea
- Ambulate within the hospital 10 meter with minimal breathlessness prior to discharge
- Understand how to perform pursed-lip breathing to manage shortness of breath prior to discharge

Decrease mobility status
- Be independent with community ambulation with or without the use of a mobility aid within the next 3 months

Currently smoking
- Join a smoking cessation program and stop smoking within 6 months

Presence of secretions
- be independent with secretion clearance and knowledgeablt of signs of pneumonia (green sputum, fever, increased feeling of malaise) prior to discharge.

Co-morbidities: HT & Type II DM
- Perform a home exercise program 2 days a week
- Join a community exercise program 2x per week within the next 6 months
Understand the signs and symptoms of hypoglycemia during exercise prior to discharge

Question 7

Overall Response

Answer 7

Emphasize Pt-centered goals
I would collaborate with the patient to understand their main concerns. I would learn what they want to work on to help create patient-centered goals.

Short-term goals:
- Ambulate within the hospital 10 meter with minimal breathlessness prior to discharge
I selected this as a short-term goal because the case states that the patient is currently ambulating with breathlessness.

• Understanding how to perform pursed lip breathing to manage SOB prior to dischrage
  I selected this as a short-term goal because it is important that the patient can perform this technique effectively to help decrease his dyspnea
• Be independent with secretion clearance and knowledgeable signs of infection (green sputum, fever, increased feeling of malaise) prior to discharged
  I selected this as a short-term goal because it is important that the Pt has a way to independently manage his current secretions and a way to identify signs/symptoms of pneumonia while out in the community.
• Perform a home exercise program 2 days a week
  I selected this as a short-term goal because an exercise program will help improve the patient’s overall strength and condition and help improve his function
• Understand the signs and symptoms of hypoglycemia during exercise prior to discahrage
  I selected this as a short-term goal because it is critical that a patient with diabetes can self-identify the signs of hypoglycemia while exercising

Long-term goals:
- Be independent with community ambulation with or without the use of mobility aid within the next 3 months
I selected this as a long-term goal because the patient was previous independent ambulating in the community and it would be important to return to his baseline level.

• Join a smoking cessation program and stop smoking within 6 months
  I selected this as a long-term goal because the patient is a smoker which negatively affects his lung health and can contribute to his emphysema exacerbations and breathlessness
• Join a community exercise program 2x per week within the next 6 months
  I selected this as a long-term goal because exercise will help with many aspects of his well-being