Life goals: the concept and its relevance to ... - Semantic Scholar

Clinical Rehabilitation 2003; 1 7: 192–202

Life goals: the concept and its relevance to rehabilitation KP Sivaraman Nair Rivermead Rehabilitation Centre, Oxford, now at Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, India Received 7th July 2001; returned for revisions 4th October 2001; revised manuscript accepted 27th October 2001.

Objective: Life goals are desired states that people seek to obtain maintain or avoid. These goals may inuence motivation to participate in the rehabilitation process. The aim of this paper is to review the literature on life goals and the inuence of life goals on the rehabilitation process. Methods: The MEDLINE, EMBASE, Psychlit and CINAHL databases were searched with the keywords goals, life goals, aim of life, meaning of life, motivation, assessment (identication) of life goals, goal planning, disability, coping and rehabilitation. Results: The initial search produced 917 abstracts. After going through these abstracts, 39 articles were selected for inclusion in the review. Age, gender, personality, experiences and society and environment inuence life goals. Pursuit and attainment of life goals affect sense of well-being. Life goals are accessible to conscious awareness and can be identied. Several questionnaires are available for assessment of life goals. Different questionnaires assess different aspects of life goals. All except one of these questionnaires need to be tested for validity and reliability in a rehabilitation setting. Disabilities interfere with goal striving and result in emotional distress. Motivation to participate in a rehabilitation programme depends on concurrence between a patient’s life goals and treatment goals. Incorporation of a subject’s life goals into a management programme resulted in better outcomes in various physical and psychiatric disorders. There are no data on the efcacy of life goal-orientated rehabilitation programmes. Conclusions: Life goals inuence patients’ motivation to participate in and compliance with treatment programmes. We still do not know whether rehabilitation programmes focusing on life goals make any difference in outcome. There is need for further studies in this area.

Address for correspondence: KP Sivaraman Nair, DP&NR, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560 029, India. e-mail: kpsnair@ hotmail.com © Arnold 2003

Downloaded from http://cre.sagepub.com at University of Hong Kong Libraries on July 1, 2010

10.1191/0269215503cr599oa

Life goals and rehabilitation 193 Introduction The concept of life goals was introduced in 1970s as a dimension of motivation. Since then an extensive volume of knowledge about life goals has accumulated in the elds of psychology, social work and rehabilitation. Life goals are the desired states that people seek to obtain, maintain or avoid.1 These goals are the ends that individuals try to achieve by means of their cognitive and behavioural strategies. They are modied by personal and contextual factors. Diseases and disabilities interrupt the pursuit of life goals, resulting in emotional distress.2 The motivation of a person to participate in the rehabilitation process depend on concurrence between the treatment goals and the subject’s life goals.3 Goal-orientated treatment programmes were found successful in rehabilitation.4 The aim of this paper is to review the literature on life goals and the inuence of these goals on the process of rehabilitation. The paper describes the methods used for literature search, results and conclusions. The results are divided into sections dealing with the nature of life goals, factors inuencing life goals, effect of life goals on health, impact of illness on life goals, tools for assessment of life goals and role of life goals in rehabilitation. Methods The MEDLINE, EMBASE, Psychlit and CINAHL databases were searched with the keywords goals, life goals, aim of life, meaning of life, assessment (identication) of life goals, goal planning, disability, coping and rehabilitation. Abstracts of all results were read. Articles dealing directly with the nature of life goals, assessment of life goals, factors inuencing life goals, Table 1

inuence of life goals on health, effect of illness and disabilities on life goals, methods of assessment of life goals and signicance of life goals to rehabilitation were selected. The reprints of these articles were obtained and read in full. Results The search of databases revealed 917 abstracts. Reprints of 72 articles were obtained and read. Thirty-nine references directly dealing with the subject were included in the review. Life goals Nature Life goals consist of a complex hierarchy (Table 1).2,5–9 At the top of this hierarchy is an overriding reference value or idealized selfimage. The desire to attain this idealized selfimage leads to abstract motivations like need for power, fame, esteem, independence and pride. 8,10 The personal goals or middle-level goals are tasks or objectives determined by these abstract motivations. They are easily recognized and expressed by the individuals and are amenable to measurement. They include goals like career, relationships and nancial security.7,8 The contextual goals are an individual’s conscious intentions and actions to orient their current environment or life situations towards personal goals.7 Examples include striving for better grades at school, attempting to perform well at sports, and trying to improve relationships. The lowest level of hierarchy of life goals consists of immediate actions and discrete events that will lead to contextual goals. They include specic actions like reading, writing, driving, etc.7 Setting of goals at any level is determined by the goal of the next level up in hierarchy.6,9 The fullment of lower level goals leads to realization of higher level motivations

Hierarchy of life goals

Level

Goal

Examples

1 2 3 4 5

Idealized self-image Abstract motivations Personal goals Contextual goals Immediate actions

Power, fame, fortune Career, family, relationships Striving for better grades at school Specic activities like reading, writing, playing


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and in turn help the individual to move closer to the idealized self-image.6 Inuences These goals are modied by various factors like age, gender, personality, affect, environment and health.5 An individual’s life goals change from early adulthood to late life (Table 2). 6 Gender inuences choice of life goals: women tend to give more importance to family, domestic and social goals, and men to economic goals and occupation.7,11 Pregnancy is a major life event that signicantly inuences and is inuenced by life goals. Parenting demands adjustment of life expectations. A study by Hudspeth et al. found that the pregnant teenagers had fewer life goals than their peers.12 Personality plays an important role in choice of life goals. Personality traits of extroversion and narcissism were correlated positively with goals of economic success, exciting lifestyle and prestigious occupation, and negatively with social goals like working for welfare of others.7 People with type A behaviour were more often dissatised with their attainment of life goals.13 The personality traits may be viewed as those facilitating or thwarting the pursuit of life goals.14 Certain personality traits may result in failure to utilize social support in goal striving. Life goals are also inuenced by earlier negative or positive experiences. Unemployed subjects with end-stage renal failure had more negative attitudes to life goals, and reported greater loss of life goals.15 Life goals and health Life goals contribute to health and psychological well-being. Several studies have shown that people with a high sense of well-being had better recognition of life goals, commitment to life goals, perception of progress towards life goals and sense of achievement of life goals.10,16,17 Table 2

Absence of life goals results in a sense of meaninglessness leading to nihilism, cynicism, apathy and suicidal ideas.18 The nature of goals also inuences emotional well-being. A preoccupation with achievement-related goals to the exclusion of relationship goals results in stress. Extrinsically orientated goals like nancial status and social standing were negatively related to sense of wellbeing.1 High levels of goal striving were associated with depression.19 How people handle the conicts while striving towards life goals inuences their sense of well-being. The degree to which individuals experienced positive or negative moods on a day was related to occurrence of events facilitating or inhibiting life goals.17,19 Life goals and illness Illness and disability interfere with pursuit of life goals and will result in emotional distress. 2 Shih et al. noted that unnished responsibilities and unattained life goals were the primary concerns of patients admitted for cardiac surgery.20 Roberts et al. observed that diagnosis of cancer interferes with the life goals of young adult patients and leads to psychological symptoms.21 Cook noted that patients with spinal cord injuries had negative perceptions towards important life goals.22 The life goals may be inuenced by physical symptoms. Karoly and Lecci noted that persons experiencing persistent pain tend to evaluate their life goals in a problematic fashion.23 The presence of pain was associated with lower ratings of self-efcacy, self-monitoring, self-reward and less positive arousal. McGrath and Adams2 used Carver and Scheier’s9 model of affect in relation to information processing to explain the emotional impact of brain injury on life goals. According this model the current action is undertaken to minimize the discrepancy between the current state and some behavioural reference (goal). Affect is experi-

Goals and stages of life6

Early adulthood

Middle age

Late life

Education Finding occupation Selection of partner Starting family Finding congenial social groups

Carrier Income Meeting demands of parenthood Nurturing marriage Managing household

Health Retirement Adjusting to reduced income Coping with bereavement Religion and life philosophy


Life goals and rehabilitation 195 enced when the rate of approach to goal is different from the desired rate. The distance from the goal is less important than the rate at which the goal is approached. When the actual rate of approach exceeds the desired rate positive emotions are experienced and where rate is slow negative emotions are experienced. The intensity and type of emotion are related to the signicance of goals and the magnitude of the rate of discrepancy. Acute brain injury results in a sudden dramatic interruption of goal-directed activity. This is followed by a gradual and steady resumption of some activities in some life areas. In the chronic progressive conditions, the rate of approach to desired goals is unpredictable. Thus, neurological disorders have a signicant negative impact on goal striving, resulting in emotional distress. McGrath and Adams noted frustration, sadness, fear, confusion and worry among subjects with brain injury.2 Frustration was the initial response to interruption or slowing of rate of approach to desired goal. Sadness or depression resulted from failure to attain a goal. Subjects experienced fear when slowing of rate of approach to a goal is anticipated, especially where the goal relates to self-preservation. Worry was the explicit cognitive aspect of monitoring the rate of approach to the desired goal. Confusion occurs when the monitoring process is disrupted because of misinformation or cognitive problems. The emotional distress described by these patients arises partly from slowing, interruption or uncertainty of rate of approach to personally meaningful goals.2

Table 3

Assessment of life goals The techniques used to study life goals are qualitative methods, life goals questionnaires and questionnaires assessing commitment to life goals (Table 3). The personal quest for a meaningful life and life goals can be analysed using written narratives The subjects were asked to write about the life goals and meaning of their life. The written descriptions were analysed using predetermined criteria. It was possible to test hypothesis and obtain statistically signicant reproducible ndings by this method.24 Goals specify what a person typically is trying to do. Craik used video recordings of person environment transactions during a lived day to analyse life goals.14 Various questionnaires are used to identify life goals. Nurmi6 and King et al.17 used open-ended questionnaires in which the subjects were asked to list their goals of life. In the study by Nurmi, the subjects were asked to write down their goals, hopes, plans and dreams in four numbered lines.6 The goals and concerns were classied independently by two assessors into one of 15 categories. The categories were: occupation, property, family, marriage, self, education, health, travel, children’s life, leisure activities, world, retirement, war, health of others, friends and others. King et al. allowed subjects to list as many goals as they wished in one page.17 Examples of common life goals given by the participants of this study were ‘nd a loving spouse’, ‘have two children’, ‘remain close to family’, and ‘be a successful paediatrician’. The number of goals listed varied from two to 30 (mean 7.9, SD 6). The open-ended questionnaires elicit self-articulated personal goals.

Methods for assessment of life goals

Qualitative methods to identify life goals

Questionnaires to identify life goals

Measures of commitment to life goals

Recorded interviews and written narratives24 Video recordings14

Open-ended questionnaires6,17 California Life Goals Evaluation Schedule25 Life Esteem Survey10 Life Goals Inventory26 Major Life Goals Questionnaire7 Questionnaire for mail survey of life goals16 Rivermead Life Goals Questionnaire3

Purpose in Life Test1,10,12 Life Regards Index18


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Several structured questionnaires have been greater meaning or purpose of life. It has good used to identify life goals. The California Life validity and reliability and has been used for Goals Evaluation Schedule has been used in sev- counselling students, vocational guidance, rehaeral studies.8,25 This questionnaire has 150 state- bilitation, treatment of alcoholism and therapy ments grouped into 10 subsections: esteem, for neurosis.10,12 Life Regards Index was an prot, fame, power, leadership, security, social instrument similar to the Purpose in Life Test. It service, interesting experience, self-expression has two 14-item subscales: the framework scale and independence. The responses are rated on a and the fullment scale. All the 28 items scored ve-point scale ranging from 1 (strongly dis- on a Likert scale: 1 (do not agree), 2 (no opinagree) to 5 (strongly agree). The scale has good ion) and 3 (agree). The framework subscale was validity and reliability.8,25 The Life Esteem Sur- designed to assess the degree to which individuvey measures the relative importance of 22 dif- als have derived a set of life goals. The fullment ferent life goals.10 The importance of each goal is scale measures the degree to which subjects see rated on a scale of one to nine. This scale also themselves as having fullled or being in the had good reliability and validity.10 Roberts and process of fullling the life goals. This scale had Robins assessed life goals using a questionnaire good validity and reliability.18 consisting of 38 life goals arranged in seven clusDifferent scales measure different aspects of ters.7 The clusters were economic, aesthetic, life goals. The California Life Goals Evaluation social, relationship, political, hedonistic and reli- Schedule and Life Esteem Survey measure gious goals. The responses were obtained in a mainly abstract motivations (Table 1). The validve-point rating scale ranging from 1 (strongly ity and reliability of these two scales were estabdisagree) to 5 (strongly agree). The study showed lished in several studies. It may not be practical a good internal consistency for the scale. to apply these scales in patients with brain injury, Raina and Vats used a 35-item life goals inven- as associated cognitive decits will interfere with tory to collect data on life goals.26 The subjects abstract reasoning. Scales used by Roberts and rated importance of each item on a four-point Robins,7 Hooker and Segler,16 and Raina and scale: 1 (of little or no importance), 2 (somewhat Vats26 focus more on personal goals. The validimportant), 3 (very important) and 4 (essential). ity and reliability of these scales were not fully These goals fell into three broad categories: per- studied. The Life Regards Index and Purpose in sonal, social and vocational. The validity and reli- Life Test estimate the extent to which the person ability of the scale were not reported. Hooker is committed to life goals. They do not identify and Siegler used a questionnaire with seven the life goals. The methods like analysis of writdomains for a mail survey of life goals.16 The ten descriptions, responses to open-ended quesdomains were: work, relationship with spouse, tionnaires and recorded interviews also assess relationship with parents, relationship with chil- personal goals, as these are better expressed by dren, relationship with friends, recreational activ- individuals. The interviews are very time conities, and civic and community activities. The suming and may not be feasible in subjects with respondents rated the importance of each domain communication problems. Problems in cognition, on a four-point rating scale: 1 (not at all impor- communication and motor control may interfere tant), 2 (somewhat important), 3 (very impor- with the ability of subjects with neurological distant) and 4 (most important). This is a simple abilities to give a good written account of life scale, which is easy to administer. However there goals. The video recordings of person–environwere no data on its validity and reliability. ment interactions probably gives information The Purpose in Life Test and Life Regards about specic actions – the lowermost level of life Index measure the commitment to life goals. Pur- goal hierarchy. Cognitive, visuospatial and locopose in Life Test was a measure of sense of motion disabilities limit interactions of patients meaning and purpose in life. The scores indicate with the physical environment. Hence this strength of a person’s overall sense of purpose. method may not be useful in this group of clients. The instrument has 20 items, which are rated on These scales were studied in populations without a scale from one to seven. Downloaded Higherfrom score indicates disabilities. The assessment of life goals in peohttp://cre.sagepub.com at University of Hong Kong Libraries on July 1, 2010

Life goals and rehabilitation 197 ple with neurological disorders is complicated by for consistency of choices over time. Neurologiproblems in communication, cognition, emotion cal disorders often result in emotional impairand motor skills. These scales were not validated ments such as hallucinations, delusions, anxiety in this group. and depression. These problems may also impair At Rivermead Rehabilitation Centre, Oxford, judgement and choice of life goals. It is impora structured questionnaire complemented by tant to tackle the emotional problems with medstructured interview is used to identify patients’ ications, counselling or psychotherapy before goals.3 This questionnaire addresses nine aspects obtaining life goals. Delay the decisions regardor areas of life. Patients rate the signicance on ing life goals as far as possible until the emotional a scale of 0 (no signicance), 1 (of some signi- state is stable. In these subjects it is also essencance), 2 (of great signicance) and 3 (of extreme tial to make repeated assessments and to check signicance) (Appendix). The scores on the life for consistency.3 goals questionnaire help the patient to indicate the relative importance of each item. Many Life goals and rehabilitation Spriggs noted that even in the face of devaspatients rate several areas as extremely important and so it is vital to ask the patient to rank tating illness people continue to make the rst three items in order if at all possible. A autonomous decisions, set goals and pursue preliminary study showed good test–retest relia- them.27 According to Lukas people with chronic bility for this questionnaire.2 Most of the subjects illness and long-term disabilities testify that life rated residential and domestic arrangements, is unconditionally worth living. There is a meanability to manage personal care and family life as ingful life for every person, regardless of his or of extreme importance. Financial status, work her life circumstances.28 Patients come to rehaand leisure received variable ratings. The major- bilitation with a system of beliefs concerning illity rated religion and life philosophy as of no ness, recovery and rehabilitation. The nature of importance. Patients who had a partner rated this their expectations will depend on the patient’s area as of extreme importance. The patients gave previous experience of similar situations, culture emphasis to relationships with partner and fam- and experiences of friends and relatives, inforily, not to work and leisure. In contrast, most mation given about the illness, attitudes of the rehabilitation services place more emphasis on professional staff and life philosophy.3 It is work and leisure and less on family and rela- important to establish which areas of life concern patients most. tionships.2 Aphasia, cognitive losses or emotional upset The success of a rehabilitation programme may make it difcult to obtain a patient’s life depends on the motivation of its clients. Motivagoals. Communication problems are common fol- tion depends, to a large extent on concurrence lowing head injury or stroke. Some idea about between a patient’s life goals and the goals set by patient’s life goals can be obtained from relatives the rehabilitation team. Many patients described who knew the patient well, but information may as unmotivated simply have goals different from be biased. The relative may not know the life those of the rehabilitation team.3 In a case study, goals and may not be aware of this fact. The Kogan reported a patient who offered resistance speech and language therapists have knowledge to psychotherapy that had goals that did not t and technical skill in obtaining relevant informa- with the patient’s life goals.29 It is the duty of the tion from these patients. Cognitive impairments team to tailor their goals to those of the patient, and lack of insight also interfere with assessment not vice versa. The team must also ensure that of life goals. Loss of ability to make judgements the patient understands and agrees that the rehaand abstract thinking will interrupt with formu- bilitation goals coincide with their life goals.3 lation and assessment of life goals. They may not Treatment programmes centred on a patient’s be able to make choices or rank multiple options. life goals have been successful in the manageIt is essential to spend as much time as possible ment of several disorders. Skantze noted that with such patients. Ask them to make simple some domains of quality of life of outpatients choices and give yes or noDownloaded responses and checkat University with schizophrenia improved signicantly with from http://cre.sagepub.com of Hong Kong Libraries on July 1, 2010

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services based on patients’ life goals.30 Thornton ing facilitation of acceptance of losses and and Hakkim suggested that a rehabilitation pro- restructuring of life goals helped in promoting gramme focused on life goals and designed to more adaptive coping. Refocusing of life goals restore the meaningful existence of people with helped people with AIDs to cope with illness end-stage renal disease improves the quality of better.38 Quite often, patients are well aware of the diflife and is cost effective.31 Addition of personal goals into a rehabilitation programme improved culties in achieving goals they have set, but do the outcome of sports injuries.32 In a randomized not acknowledge this.39 They should be helped to controlled trial, Glasgow et al. noted that the change this denial behaviour, develop a more introduction of patient-centred goal setting led to positive coping skill and move on to a more realprolonged changes in dietary behaviour in peo- istic goal. Many subjects do not have insight into ple with diabetes.33 Setting individual goals led to their problems. They do not recognize the barrimore efcient and effective tness training in ers of impairments and disabilities. These subpeople with chronic airway limitation.34 Bauer jects require assistance in understanding the and McBride suggested that a life goals group requirements to full their life goals, their curpsychotherapy programme was successful in the rent and likely future situation and possible alternatives. This realization often causes anxiety and treatment of bipolar affective disorders.35 It is good practice to involve patients in setting emotional distress. The rehabilitation team their own goals. Increased involvement of should help clients to cope with negative emopatients in their process of goal planning led to tions due to the disruption of goal striving. One maintenance of gains made.4 However there was approach is to examine the relation between only one study directly dealing with the benets unachievable goals and a person’s idealized selfof a rehabilitation programme centred on image. These goals may need to be disconnected patients’ life goals. McGrath and Adams noted from the ideal self-image. Then, the failure to that patient-centred goal planning improved the achieve them will not be of emotional signimood of the subjects.2 Evidence on the efcacy cance. The person can turn to a new goal domain of the incorporation of patients’ life goals into a or adopt a less exacting standard in the same domain.2 Schultze and Ososke suggested that rehabilitation programme is still lacking. Figure 1 shows a owchart for a rehabilitation counselling based on the principles of Brief programme based on life goals. The rehabilita- Therapy is useful in this setting. The intervention tion team, using knowledge about prognosis, consists of validation, compliment and suggesavailable interventions, resources and environ- tion.39 ‘Validation’ is the acknowledgement of ment, should assess the life goals obtained from difculties that the patient is facing in goal strivpatients. Many of the life goals of clients may ing and normalizing the experience. ‘Compliturn out to be unrealistic and not achievable. ment’ is the recognition of their efforts in relation Subjects are required to restructure their life to goal attainment. ‘Suggestion’ is the introducgoals. Coping with loss of life goals and refocus- tion of the task they need to perform to attain ing on achievable goals are essential for the suc- the goals. The tasks also include change in behavcess of rehabilitation. Patients with rheumatoid iour, development of coping skills, obtaining arthritis who coped by restructuring life goals insight and focus on achieving realistic goals. were found to have better psychological adjustThe rate of recovery from neurological disorment and functional status than patients who ders is often slow and may not match with hoped for unrealistic solutions or who engaged in patients’ expectations. It may be disappointing to self-blame.36 Post and Collins suggested that in learn that recovery may take longer time than patients with chronic obstructive pulmonary dis- expected. The slow rate of approach to personease, a lack of adjustment in expectations and life ally meaningful goals results in emotional disgoals led to difculty in accepting illness, chronic tress.2 The patients should be able to develop anxiety, attribution of responsibility to external realistic expectations about the rate at which factors and poor compliance with medical goals will be approached. This occurs through regime.37 Psychotherapeutic interventions includprovision expert on prognosis and Downloaded from http://cre.sagepub.com at University of Hong Kong of Libraries on July 1, information 2010

Life goals and rehabilitation 199

Figure 1

Rehabilitation programme based on life goals.

exposure to other patients with similar condi- Patients with disturbances in memory may need tions. to be repeatedly reminded about this. At RiverMany subjects do not appreciate the signi- mead Rehabilitation Centre, patients and family cance of various therapies. They fail to link daily members are invited to participate in all goaltreatment routines to life goals and will not be planning meetings, except the initial one. A copy motivated to participate in the therapies. These of the summary of the meeting is also given to patients should be made aware that the basic them. This helps both the patient and family to therapeutic activities are linked to higher order keep in mind the links between what may be borlife goals. The achievement of their life goals ing, repetitive or unpleasant daily therapies and depends on success in attaining the treatment deeply valued goals, such as returning to home goals. The patients should be helped to relate or work. 2 basic, daily treatment routines to from their life goals.at UniversityThe lifeLibraries goals expressed by the patients may Downloaded http://cre.sagepub.com of Hong Kong on July 1, 2010

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change during the course of a rehabilitation programme. This may be due to two reasons. During the initial phases of rehabilitation it may be difcult to get a true picture of what the patient wants or is expecting from the team. Impaired communication and cognitive decits may interfere with the patient’s ability to express life goals. Neuropsychological interventions may improve cognitive status. Speech therapy may improve their ability to communicate. As a result of all these changes, the rehabilitation team will be able to obtain a better understanding of the patient’s goals after he or she has been in the programme for a while. The rehabilitation often results in reduction in disabilities even though the impairments may not change. The degree of independence in activities of daily living and mobility may become better. These improvements may result in the patient setting more ambitious goals. Hence it is important to review the life goals periodically. At Rivermead Rehabilitation Centre, life goals are obtained from patients before each goal-planning meetings. These meetings usually occur once in six weeks. The role of the rehabilitation team with regard to patients’ life goals include: 1) Identication of life goals. 2) Analysis of life goals in view of prognosis, impairments, disabilities, handicap, available resources and patient’s environment. Decide whether the goals are achievable or unachievable. 3) Help subjects with unachievable goals to cope with loss of life goals and develop attainable goals. 4) Help subjects develop realistic expectations about rate of progress towards life goals. 5) Plan and implement a rehabilitation programme orientated towards patient’s life goals. 6) Help patients’ to relate treatment goals to life goals. 7) Periodic reviews to identify changes in life goals and make suitable changes in the programme.

Clinical messages Life goals are objectives that a person strives to attain or avoid. They are hierarchically organized, accessible to conscious awareness and can be identied. Life goals may inuence participation in rehabilitation programme. It is not clear whether rehabilitation programmes focusing on life goals will improve outcome.

Conclusions Life goals are hierarchically organized and are inuenced by various physical and psychological factors. Illness and disabilities interfere with pursuit of life goals. Interruption of life goals results in emotional distress. Different questionnaires assess different aspects of life goals. Most of the currently available life goal questionnaires need to be tested for validity and reliability in a rehabilitation setting. Incorporation of a subject’s life goals into a management programme results in better outcomes in various physical and psychiatric disorders. It is still not clear whether rehabilitation programmes focusing on life goals make any difference in outcome. Further studies are required to answer this question. Acknowledgement Commonwealth Association of Universities, London, supported KP Sivaraman Nair during the period of this study. References

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Appendix – Rivermead Life Goals Questionnaire3 Various aspects and areas of life are given below. I would like you to tell me how important each is to you. Please rate the importance of each: 0 = of no importance, 1 = of some importance, 2 = of great importance and 3 = of extreme importance. 1) 2) 3) 4) 5) 6) 7) 8) 9)

My My My My My My My My My

residential and domestic arrangements (where I live and who with) are : ability to manage my personal care (dressing, toilet, washing) is : leisure, hobbies and interests including pets are : work, paid or unpaid is : relationship with my partner (or my wish to have one) is : family life (including with those not living at home) is : contacts with friends, neighbours and acquaintances are : religion or life philosophy is : nancial status is :

0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3

Courtesy of Rivermead Rehabilitation Centre, Abingdon Road, Oxford, UK. Reproduce freely, but acknowledge source and do not sell.
