***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The effectiveness of three nursing approaches in fostering self-care behaviors in elderly nursing home residents was compared . The study was conducted in three intermediate care nursing homes . Each home was r and omly assigned to one of three conditions : a combination of behavior modification and mutual goal setting ( Condition 1 ) , mutual goal setting only ( Condition 2 ) , and routine nursing care ( Condition 3 ) . Seventy-nine subjects completed the study . In-service training was provided to nursing staff in Conditions 1 and 2 but not in Condition 3 . Over a period of 22 weeks , nursing staff encouraged subjects to departs of their morning activities of daily living ( ADLs ) independently . When the groups were compared on self-care behaviors at the end of the 22 weeks , subjects who received the combination treatment performed significantly more self-care behaviors than those in the other two groups Background The majority of individuals with type 2 diabetes do not exercise regularly . Pedometer-based walking interventions can help ; however , pedometer-based interventions targeting only total daily accumulated steps might not yield the same health benefits as physical activity programs specifying a minimum duration and intensity of physical activity bouts . Methods This pilot r and omized trial compared two goal - setting strategies : 1 ) lifestyle goals targeting total daily accumulated step counts and 2 ) structured goals targeting bout steps defined as walking that lasts for 10 minutes or longer at a pace of at least 60 steps per minute . We sought to determine which goal - setting strategy was more effective at increasing bout steps . Participants were sedentary adults with type 2 diabetes . All participants : wore enhanced pedometers with embedded USB ports ; uploaded detailed , time-stamped step-count data to a website called Stepping Up to Health ; and received automated step-count feedback , automatically calculated goals , and tailored motivational messages throughout the six-week intervention . Only the automated goal calculations and step-count feedback differed between the two groups . The primary outcome of interest was increase in steps taken during the previously defined bouts of walking ( lasting at least 10 minutes or longer at a pace of at least 60 steps per minute ) between baseline and end of the intervention . Results Thirty-five participants were r and omized and 30 ( 86 % ) completed the pilot study . Both groups significantly increased bout steps , but there was no statistically significant difference between groups . Among study completers , bout steps increased by 1921 ± 2729 steps a day . Those who received lifestyle goals were more satisfied with the intervention ( p = 0.006 ) and wore the pedometer more often ( p < 0.001 ) than those who received structured goals . Conclusion In this six-week intervention , Lifestyle Goals group participants achieved increases in bout steps comparable to the increases seen in the Structured Goals group , representing almost a mile a day of additional moderate intensity bout activity . Pedometer-based walking programs that emphasize total accumulated step counts are more acceptable to participants and are as effective at increasing moderate intensity bouts of physical activity as programs that use structured goals .Trial registration Objective : To examine the effects of a goal setting intervention on self-efficacy , treatment efficacy , adherence and treatment outcome in patients undergoing low back pain rehabilitation . Design : A mixed-model 2 ( time ) × 3 ( group ) r and omized controlled trial . Setting : A residential rehabilitation centre for military personnel . Subjects : UK military personnel volunteers ( N = 48 ) ; mean age was 32.9 ( SD 7.9 ) with a diagnosis of non-specific low back pain . Interventions : Subjects were r and omly assigned to either a goal setting experimental group ( Exp , n = 16 ) , therapist-led exercise therapy group ( C1 , n = 16 ) or non-therapist-led exercise therapy group ( C2 , n = 16 ) . Treatment duration for all groups was three weeks . Main measures : Self-efficacy , treatment efficacy and treatment outcome were recorded before and after the treatment period . Adherence was rated during regularly scheduled treatment sessions using the Sports Injury Rehabilitation Adherence Scale ( SIRAS ) . The Biering-Sørensen test was used as the primary measure of treatment outcome . Results : ANCOVA results showed that adherence scores were significantly higher in the experimental group ( 13.70 ± 1.58 ) compared with C2 ( 11.74 ± 1.35 ) , ( P < 0.025 ) . There was no significant difference for adherence between the experimental group and C1 ( P = 0.13 ) . Self-efficacy was significantly higher in the experimental group compared to both C1 and C2 ( P < 0.05 ) , whereas no significant difference was found for treatment efficacy . Treatment outcome did not differ significantly between the experimental and two control groups . Conclusions : The findings provide partial support for the use of goal setting to enhance adherence in clinical rehabilitation The purpose of this study was to determine how an exercise adherence intervention affects the physiological , functional , and quality of life outcomes of patients with heart failure ( HF ) . Sixteen HF patients were r and omly assigned to an  exercise-only group  ( n = 8) or to an  exercise-with-adherence group ( n = 8) . Two of the 16 people  died from nonexercise related causes during the study and were not included in the analysis . The intervention was tested over a 24-week period in which patients participated in a 12-week supervised exercise program ( Phase 1 ) followed by 12 weeks of unsupervised home exercise ( Phase 2 ) . The intervention format was one of individualized graphic feedback on exercise goals and participation and problem-solving support by nurses . Results indicate that patients who received the intervention exercised more frequently and experienced improved outcomes during both phases . The adherence intervention may encourage HF patients to continue to exercise and thereby maintain the health benefits gained in both phases of an exercise program OBJECTIVE Few studies have examined the effect of goal difficulty on behavioral change even though goal setting is widely used in diabetes education . The effect of a goal to consume either 6 or 8 servings/day of low glycemic index ( LGI ) foods was evaluated in this study . METHODS Adults 40 - 65 years old with type 2 diabetes were r and omly assigned to the 6 or 8 serving/day treatment group following a 5-week GI intervention .  Perceived goal difficulty , commitment , satisfaction , and self-efficacy were evaluated , and four day food records assessed dietary intake . RESULTS Both groups increased consumption of LGI foods ( P<0.001 ) ; there were no significant differences in the change in consumption between groups . Participants who were more committed to the goal perceived the goal to be less difficult ( P<0.01 ) . Those with greater efficacy beliefs were more committed to their goal , perceived the goal to be less difficult , and were more satisfied with their performance ( all P<0.05 ) . CONCLUSION A specific goal regarding LGI foods can facilitate the adoption of a lower GI diet . Future research is needed to determine if goal commitment or goal difficulty mediate the process . PRACTICE IMPLICATION S Clinicians should help clients set specific goals regarding dietary change Objective : To determine the feasibility , the cluster design effect and the variance and minimal clinical importance difference in the primary outcome in a pilot study of a structured approach to goal - setting . Design : A cluster r and omized controlled trial . Setting : Inpatient rehabilitation facilities . Subjects : People who were admitted to inpatient rehabilitation following stroke who had sufficient cognition to engage in structured goal - setting and complete the primary outcome measure . Interventions : Structured goal elicitation using the Canadian Occupational Performance Measure . Main measures : Quality of life at 12 weeks using the Schedule for Individualised Quality of Life ( SEIQOL-DW ) , Functional Independence Measure , Short Form 36 and Patient Perception of Rehabilitation ( measuring satisfaction with rehabilitation ) . Assessors were blinded to the intervention . Results : Four rehabilitation services and 41 patients were r and omized . We found high values of the intraclass correlation for the outcome measures ( ranging from 0.03 to 0.40 ) and high variance of the SEIQOL-DW ( SD 19.6 ) in relation to the minimally importance difference of 2.1 , leading to impractically large sample size requirements for a cluster r and omized design . Conclusions : A cluster r and omized design is not a practical means of avoiding contamination effects in studies of inpatient rehabilitation goal - setting . Other techniques for coping with contamination effects are necessary UNLABELLED This study adopted a perspective of the individual to define domains of everyday life for the analysis of clinical ly meaningful change . The purpose was to compare the clinical significance of two interventions for patients with musculoskeletal pain , applying an idiographic outcome measure , The Patient Goal Priority Question naire , in combination with the Jacobson and Truax methodology [ ( 1991 ) . CLINICAL SIGNIFICANCE A statistical approach to defining meaningful change in psychotherapy research . Journal of Consulting and Clinical Psychology , 67 ( 3 ) , 300 - 307 ] for determination of clinical significance . The concurrent validity of the outcome variables behavioral performance , satisfaction with behavioral performance , and fulfilled pre-treatment expectations was also studied . Eighty-two patients , r and omized to either individually tailored behavioral medicine treatment ( experimental group ) or physical exercise therapy ( control group )  were evaluated at baseline and 3 months post-treatment regarding behavioral treatment goals . The experimental intervention had high impact on participants ' performance of their highest ranked everyday life activities , and result ed in larger proportions of clinical ly significant outcomes compared with controls . The concurrent validity of the outcomes was high for those reporting clinical ly significant changes , but more generally , there was a moderate agreement across outcome categories . The individual should be the unit for analyses of clinical significance to enhance the ecological validity of the construct . Further development of idiographic outcome measures is necessary , as is the inclusion in pain intervention research INTRODUCTION Health services delivered in an older person 's home are often implemented at a critical juncture in an individual 's functional status . Although homecare has potential to improve this situation , it often focuses on treating disease and ' taking care ' of the patient rather than promoting independence . The aim of restorative homecare is to change the philosophy from one where delivery of care may create dependency to provision of care which maximises independence , self-esteem , self-image and quality of life , and reduces the care required . AIMS To assess impact of a design ated goal facilitation tool on health-related quality of life ( HRQoL ) , social support and physical function among community-dwelling older people referred for homecare . METHODS A total of 205 participants [ mean age 79.1 years , 71.3 % female ( intervention group ) and 76.9 years with 60.8 % female ( control group ) ] were cluster r and omised to an intervention or control assessor . The intervention arm involved participants completing a goal facilitation tool with assessors . This established rehabilitation aims . Control participants received a st and ard needs assessment . Clients from both groups were then referred to a homecare organisation for service delivery . RESULTS There was greater change over time in HRQoL [ measured by Short Form 36 Survey ( SF-36 ) ] in the intervention group ( P = 0.0001 ) . There was a marked variation across homecare providers in types of services provided ( P < 0.001 ) . Identification of a goal did not predict completion of a formalised review of participants ' needs by the homecare organisation . CONCLUSIONS Use of a goal facilitation tool in assessment of an older person 's needs on referral for homecare leads to significant improvements in HRQoL. This may be through a higher proportion of individualised activities tailored to a successful identification of the person 's goals . The findings contribute to greater underst and ing of factors necessary to implement improvements in homecare services for older people Objectives : The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care . However , few protocol s 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 st and ard 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 Residents and staff of a nursing home in a metropolitan area were r and omly assigned to three conditions to : ( a ) test whether staff 's use of operant behavioural management strategies ( Condition 1 ) would cause a greater increase in residents '  self-care behaviour than staff 's use of mutual goal setting ( Condition 2 ) or routine nursing care ( Condition 3 ) , and ( b ) examine how useful group scores were , compared to individual scores , in determining change in individual residents ' behaviour due to treatment . In-service training was provided to staff in Conditions 1 and 2 but not in Condition 3 . Over a period of 2 
    Output:
    
No conclusive evidence was found to support the notion that goal setting , or structured goal setting in comparison to " usual care " goal setting , changes outcomes for patients for measures of participation , activity , or engagement in rehabilitation programs .
CONCLUSIONS This review found a large and increasing amount of research being conducted on goal setting in rehabilitation .
Further research is highly likely to change reported estimates of effect size arising from goal setting in rehabilitation