"what do you expect from physiotherapy?": A detailed analysis of goal setting in physiotherapy

Purpose: Health care practice guidelines require physiotherapists to include patients in goal-setting. However, not much is known about how this process is accomplished in practice. The purpose of this study is to analyse patient-physiotherapist consultations and to identify how physiotherapists enquire about goals and how patients respond to these enquiries. Method: 37 consenting patients and their physiotherapist from outpatient physiotherapy practice settings were videotaped. Conversation analysis was used to transcribe and analyse the data. Results: In 11 cases, physiotherapists enquire explicitly about goals. Patients' responses indicate that problems can arise when therapists' questions treat it as expected that the patient has a goal already in mind, and has sufficient understanding about "physiotherapy-relevant" goals. Patients' difficulties with stating a goal are related to patients' knowledge to propose a goal and whether they treat consultations as one in which it is appropriate to claim knowledge about goals. Conclusions: Goal-setting is not a straightforward process. Practices that entail asking patients to state their goals neither take into consideration the fact that patients may not know what an achievable goal is nor do they consider so-called social reasons for patients not to make claims to their physiotherapist about what the goals should be.Implications for RehabilitationPatients respond to explicit goal enquiries using an open question with delayed responses indicating some communication problem.Goal-setting should not be treated as a predetermined process, but as negotiated in consultations.Goal-setting is a complex interaction in which participants manage knowledge about goals.