"The goal is to be more flexible"--detailed analysis of goal setting in physiotherapy using a conversation analytic approach

Abstract

Standards of practice in physiotherapy require professionals to set goals in collaboration with patients. Some evidence exists regarding outcome, but no studies have investigated the process of goal setting in orthopaedic physiotherapy. The objective of this pilot study is to describe the interaction between professionals and patients in the activity of goal setting. Three physiotherapists in an orthopaedic outpatient department audio-recorded initial patient consultations. Conversation analysis (hereafter CA), a qualitative research method, is used to illustrate participants' interaction in regards to turn taking, how talk is organised, what vocabulary they use and how they respond to each other's utterances. Four distinct phases are found: eliciting patients' preferences; introduction of goal setting activity; formulating goals; and closing the activity of goal setting. Formulating questions to elicit patients' preferences requires considerable effort. Constant adjustment is needed in order to achieve goals acceptable to both participants. Goal setting is time-consuming if the patient is actively involved. Closing of goal setting activity in physiotherapy is comparable to this activity in doctor-patient interaction. In conclusion it is not straightforward to formulate and negotiate treatment goals collaboratively with patients. A balance has to be found between the input of physiotherapists and patients during the process.