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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 challenge.

Multi-faceted Factors Impacting Functioning

Real-life outcomes are dependent not only upon the success of medical intervention, but also on the subsequent rehabilitative interventions and the person himself. While it is well-documented that upper extremity surgery is effective for increasing functionality,81516 surgery and the treatment scheme alone may not guarantee positive results, as was evident three weeks into Peter’s medical management. Outcomes are also affected by the person's level of participation and acceptance of responsibility in the rehabilitation process, as well as the healthcare professional-patient interaction. Peter’s case illustrates this well.

Shared Goal-setting

Moving away from the initial Rehab-Cycle® that solely focused on hand recovery to a new Rehab-Cycle® that additionally addressed factors beyond medical management was beneficial. In this new Rehab-Cycle®, shared goal-setting proved to be essential.

The introduction of common and meaningful goals can lead to increased motivation in patients.131718 In Peter’s case, an absence of common, mutually-agreed goals, beyond those set for the post-surgery treament scheme, impacted his overall motivation within the rehabilitation program. Thus, proper individualized goal-setting undertaken through shared decision-making is critical.1219

"" absence of common, mutually-agreed goals, beyond those set for the post-surgery treatment scheme, impacted his overall motivation...""

Goals have been shown to achieve positive results in self-care tasks, and also function well as a concrete measure with respect to rehabilitation.{cs1-fn20}{cs1-fn21} Important for goal attainment is the consideration of both the health professional and the patient perspectives.17 This was clearly illustrated in Peter's case.

Peter, his physician and the psychologist on the rehabilitation team together decided on the most appropriate and achievable goals to strive for in the new Rehab-Cycle®: cycle goal 1 ‘independent transferring while sitting’ reflected Peter's wish, while cycle goal 3 ‘carrying out a daily routine’ reflected the rehabilitation team's perspective. Cycle goal 2 ‘hand and arm use’, or specifically improved grab functions, was one goal that required more discussion. Although the patient and health professional perspectives can seem to be incongruent at times, the process of reconciling this incongruency itself could benefit the goal-setting process. This was exemplified by the process of setting Peter's service-program goal; despite concerns from the rehabilitation team, the team together with Peter agreed on the service-program goal of ‘going home on weekends’.

""When both perspectives are understood, common goals can be defined.""

Peter’s defiant and non-constructive behaviour offered the rehabilitation team an opportunity to better define goals that would lead to real and positive rehabilitation outcomes. Once clear and common goals were set, Peter showed continual improvement in both compliance and functioning. Although he prematurely discharged himself from the rehabilitation centre two weeks before the end of the program and did not meet the goals in all intervention targets, the concrete and realistic goals established helped contribute to significant progress in Peter's rehabilitation.