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Should patients participate in clinical decision making? An optimised balance block design controlled study of goal setting in a rehabilitation unit
  1. Rosaline C Holliday1,
  2. Stefan Cano1,
  3. Jennifer A Freeman2,
  4. E Diane Playford1
  1. 1Institute of Neurology, University College London, London, UK
  2. 2Faculty of Health and Social Work, Plymouth University, Devon, UK
  1. Correspondence to:
 Dr E D Playford
 Box 113, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; D.Playford{at}


Objectives: The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care. However, few protocols exist to support this. One potentially useful method is goal setting, but little has been done to evaluate the added value of increasing patient participation in this way. Therefore, this study examined the impact of an increased participation goal setting protocol in a neurorehabilitation setting.

Design: The study was an AB optimised balance block design with each block lasting 3 months, over an 18 month period.

Setting and participants: Patients (n = 201) were recruited from an inpatient neurological rehabilitation unit.

Interventions: Patients (n = 100) recruited in phase A were involved in “usual practice” goal setting. Patients (n = 101) recruited in phase B were involved in “increased participation” goal setting, which included a protocol to help them define and prioritise their own goals.

Main outcome measures: Patients’ perceptions of the relevance of goal setting and their autonomy within the process; the number, type and outcome of goals; and level of functional ability.

Results: Phase B patients (“increased participation”) set fewer goals, of which significantly more were participation related. These patients perceived the goals to be more relevant, and expressed greater autonomy and satisfaction with goal setting. There were no differences in functional outcomes between the groups.

Conclusion: This study has shown that patients prefer increased participation in the goal setting process over standard procedures, perceiving their goals as more relevant and rehabilitation more patient centred despite the absence of functional gains. Effective patient centred care can be realised by using structures that help support patients to identify and communicate their priorities. As such, our findings suggest patients would benefit from greater participation in this aspect of clinical decision making.

  • FIM, Functional Independence Measure
  • GHQ-28, General Health Questionnaire

Statistics from


  • * This scale describes the amount of “participation” an individual has in decision making and may more accurately be described as an autonomy scale. Throughout the rest of the paper the word participation is used as suggested by the World Health Organisation International Classification of function to mean engagement with social roles.

  • Published Online First 23 January 2007

  • The study was funded by the UCLH Clinical Research and Development Committee.

  • Competing interests: None.

  • Dr Diane Playford conceived the study and accepts full responsibility for the conduct of the study, had access to the data and controlled the decision to publish. Ms Ros Holliday coordinated the project and collected, analysed and interpreted the data, and drafted the first version of the paper. Dr Jennifer Freeman and Dr Stefan Cano contributed to supervising the data analysis and interpreting the data and revised the paper critically. All authors contributed to the writing of the paper and approved the final version to be published.

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