As illustrated in Peter’s case, the translation of the results of a surgical intervention such as upper extremity surgery into positive, meaningful outcomes for a patient can present a significant rehabilitative challenge.

Real-life results are dependent not only upon the success of medical intervention, but also on the patient himself and the subsequent rehabilitative interventions. These are effected by an individual patient’s engagement and acceptance of responsibility for the process, as well as the healthcare professional-patient interaction. Peter’s case offers an illustrative example. While it is well-documented that upper extremity surgery is effective for increasing functionality,^{13 14 15} surgery and the treatment scheme alone may not guarantee positive results, as was evident three weeks into Peter’s medical management.

The initiation of a new ICF-based Rehab Cycle after having realized that Peter’s situation was not improving was certainly beneficial. As is well documented from studies, the introduction of common and meaningful goals leads to increased motivation in patients.^{16 17} Notably, the ICF has been promoted as a conceptual framework for documenting the patient’s problems related to hand function after upper extremity surgery in tetraplegic patients.¹⁸

In Peter’s case, an absence of common, agreed-upon goals beyond those set by the surgery treatment scheme impacted his overall motivation towards the program. Thus, proper goal-setting based upon an individual patient and undertaken through shared decision-making is critical. This process offers healthcare teams a valuable tool for determining a patient-oriented rehabilitation plan.^{19 20}

Goals have been shown to achieve positive results in self-care tasks among patients and also function well as a concrete measure with respect to rehabilitation.^{21 22} Peter’s behavior exemplified a strong need for common goal setting and offered an opportunity for the health care team to better define goals that were expected to lead to real and positive rehabilitative outcomes.

This case highlights the need for both healthcare professional and patient perspectives:^{23 24} a single perspective gives an incomplete picture. And although the patient and health care perspectives seem at times to be contradictory (such as “can’t pick things up” and “wearing a brace and cast”), the patient perspective facilitates a process based on goal-oriented solutions that can increase his or her motivation.

When both perspectives are understood, common goals can be defined. In Peter’s case, it was the involvement of both the patient, his physician and a psychologist who together defined which were the most appropriate and achievable goals: one was Peter’s own – transferring / changing position; one arose from the healthcare perspective – carrying out a daily routine; and one was a discussion point – increasing grab functions. All of the cycle goals worked to achieve the program goal that was central to Peter’s very own wishes: going home on the weekends.

Once these common goals were set, Peter showed continual improvement in both compliance and functioning. Although he discharged himself from the rehabilitation center two weeks before the end of the program and did not meet all targets in the final evaluation, once concrete and realistic goals had been established, continual and significant progress was made.