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Life goals: The concept and its relevance to rehabilitation

Article  in  Clinical Rehabilitation · April 2003

DOI: 10.1191/0269215503cr599oa · Source: PubMed

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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 inuence motivation to participate in the rehabilitation
process. The aim of this paper is to review the literature on life goals and the
inuence 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 (identiŽcation) 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 inuence life goals.
Pursuit and attainment of life goals affect sense of well-being. Life goals are
accessible to conscious awareness and can be identiŽed. 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 efŽcacy of life goal-orientated rehabilitation programmes.
Conclusions: Life goals inuence 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
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© Arnold 2003 10.1191/0269215503cr599oa

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 Želds of psychology,
social work and rehabilitation. Life goals are the
desired states that people seek to obtain, main-
tain or avoid.1 These goals are the ends that indi-
viduals try to achieve by means of their cognitive
and behavioural strategies. They are modiŽed by
personal and contextual factors. Diseases and dis-
abilities interrupt the pursuit of life goals, result-
ing 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-orien-
tated treatment programmes were found success-
ful in rehabilitation.4
The aim of this paper is to review the litera-
ture on life goals and the inuence 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 inuencing 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 key-
words goals, life goals, aim of life, meaning of
life, assessment (identiŽcation) of life goals, goal
planning, disability, coping and rehabilitation.
Abstracts of all results were read. Articles deal-
ing directly with the nature of life goals, assess-
ment of life goals, factors inuencing life goals,
Table 1 Hierarchy of life goals
Level Goal
1 Idealized self-image
2 Abstract motivations
3 Personal goals
4 Contextual goals
5 Immediate actions
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Life goals and rehabilitation 193
inuence of life goals on health, effect of illness
and disabilities on life goals, methods of assess-
ment of life goals and signiŽcance 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 self-
image. The desire to attain this idealized self-
image 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 moti-
vations. They are easily recognized and expressed
by the individuals and are amenable to measure-
ment. They include goals like career, relation-
ships and Žnancial 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 hier-
archy of life goals consists of immediate actions
and discrete events that will lead to contextual
goals. They include speciŽc 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 fulŽlment of lower level goals
leads to realization of higher level motivations
Examples
Power, fame, fortune
Career, family, relationships
Striving for better grades at school
SpeciŽc activities like reading, writing, playing
194 KP Sivaraman Nair
and in turn help the individual to move closer to
the idealized self-image.6
Inuences
These goals are modiŽed 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 Gen-
der inuences 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 signiŽcantly inuences and is inuenced 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 presti-
gious occupation, and negatively with social goals
like working for welfare of others.7 People with
type A behaviour were more often dissatisŽed
with their attainment of life goals.13 The person-
ality traits may be viewed as those facilitating or
thwarting the pursuit of life goals.14 Certain per-
sonality traits may result in failure to utilize social
support in goal striving. Life goals are also inu-
enced 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 psycholog-
ical well-being. Several studies have shown that
people with a high sense of well-being had bet-
ter 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 Goals and stages of life6
Early adulthood
Education
Finding occupation
Selection of partner
Starting family
Finding congenial social groups
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Absence of life goals results in a sense of mean-
inglessness leading to nihilism, cynicism, apathy
and suicidal ideas.18 The nature of goals also
inuences emotional well-being. A preoccupation
with achievement-related goals to the exclusion
of relationship goals results in stress. Extrinsically
orientated goals like Žnancial status and social
standing were negatively related to sense of well-
being.1 High levels of goal striving were associ-
ated with depression.19 How people handle the
conicts while striving towards life goals inu-
ences their sense of well-being. The degree to
which individuals experienced positive or nega-
tive 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 unŽnished responsibilities
and unattained life goals were the primary con-
cerns 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 inuenced by phys-
ical symptoms. Karoly and Lecci noted that per-
sons experiencing persistent pain tend to
evaluate their life goals in a problematic fash-
ion.23 The presence of pain was associated with
lower ratings of self-efŽcacy, self-monitoring,
self-reward and less positive arousal.
McGrath and Adams2 used Carver and
Scheier’s9 model of affect in relation to informa-
tion 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-
Middle age Late life
Carrier Health
Income Retirement
Meeting demands of parenthood Adjusting to reduced income
Nurturing marriage Coping with bereavement
Managing household Religion and life philosophy

enced when the rate of approach to goal is dif-
ferent 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 emo-
tions are experienced and where rate is slow neg-
ative emotions are experienced. The intensity
and type of emotion are related to the signiŽ-
cance of goals and the magnitude of the rate of
discrepancy. Acute brain injury results in a sud-
den dramatic interruption of goal-directed activ-
ity. 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 signiŽcant negative
impact on goal striving, resulting in emotional
distress.
McGrath and Adams noted frustration, sad-
ness, 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. Confu-
sion occurs when the monitoring process is dis-
rupted because of misinformation or cognitive
problems. The emotional distress described by
these patients arises partly from slowing, inter-
ruption or uncertainty of rate of approach to per-
sonally meaningful goals.2
Table 3 Methods for assessment of life goals
Qualitative methods to identify Questionnaires to identify life
life goals goals
Recorded interviews and Open-ended questionnaires6,17
written narratives24 California Life Goals Evaluation
Video recordings14 Schedule25
Life Esteem Survey10
Life Goals Inventory26
Major Life Goals Questionnaire7
Questionnaire for mail survey of
life goals16
Rivermead Life Goals
Questionnaire3
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Life goals and rehabilitation 195
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 writ-
ten descriptions were analysed using predeter-
mined criteria. It was possible to test hypothesis
and obtain statistically signiŽcant reproducible
Žndings 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 classiŽed indepen-
dently by two assessors into one of 15 categories.
The categories were: occupation, property, fam-
ily, marriage, self, education, health, travel, chil-
dren’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
‘Žnd a loving spouse’, ‘have two children’,
‘remain close to family’, and ‘be a successful pae-
diatrician’. The number of goals listed varied
from two to 30 (mean 7.9, SD 6). The open-ended
questionnaires elicit self-articulated personal
goals.
Measures of commitment to life
goals
Purpose in Life Test1,10,12
Life Regards Index18
196 KP Sivaraman Nair

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, reha-
eral 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
proŽt, 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 fulŽlment scale. All the 28 items scored
Žve-point scale ranging from 1 (strongly dis- on a Likert scale: 1 (do not agree), 2 (no opin-
agree) 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 individu-
vey measures the relative importance of 22 dif- als have derived a set of life goals. The fulŽlment
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 fulŽlled or being in the
had good reliability and validity.10 Roberts and process of fulŽlling 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 clus- Different 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 valid-
Žve-point rating scale ranging from 1 (strongly ity and reliability of these two scales were estab-
disagree) 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 deŽcits 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 valid-
important), 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 writ-
domains for a mail survey of life goals.16 The ten descriptions, responses to open-ended ques-
domains 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 con-
ities, 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 dis-
tant) 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–environ-
were no data on its validity and reliability. ment interactions probably gives information
The Purpose in Life Test and Life Regards about speciŽc actions – the lowermost level of life
Index measure the commitment to life goals. Pur- goal hierarchy. Cognitive, visuospatial and loco-
pose 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
http://cre.sagepub.com disabilities.
at University The
of Hong Kong Libraries assessment
on July 1, 2010 of life goals in peo-
 Life goals and rehabilitation 197

ple with neurological disorders is complicated by for consistency of choices over time. Neurologi-
problems in communication, cognition, emotion cal disorders often result in emotional impair-
and 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 impor-
a structured questionnaire complemented by tant to tackle the emotional problems with med-
structured interview is used to identify patients’ ications, counselling or psychotherapy before
goals.3 This questionnaire addresses nine aspects obtaining life goals. Delay the decisions regard-
or areas of life. Patients rate the signiŽcance on ing life goals as far as possible until the emotional
a scale of 0 (no signiŽcance), 1 (of some signiŽ- state is stable. In these subjects it is also essen-
cance), 2 (of great signiŽcance) and 3 (of extreme tial to make repeated assessments and to check
signiŽcance) (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
patients rate several areas as extremely impor- Spriggs noted that even in the face of devas-
tant and so it is vital to ask the patient to rank tating illness people continue to make
the Žrst 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 mean-
ability 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 reha-
and leisure received variable ratings. The major- bilitation with a system of beliefs concerning ill-
ity 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, infor-
ily, 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
tionships.2 patients most.
Aphasia, cognitive losses or emotional upset The success of a rehabilitation programme
may make it difŽcult to obtain a patient’s life depends on the motivation of its clients. Motiva-
goals. 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 Žt
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 reha-
and 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 manage-
It 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
from http://cre.sagepub.com with schizophrenia
of Hong improved signiŽcantly with
Kong Libraries on July 1, 2010
198 KP Sivaraman Nair

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
life and is cost effective.31 Addition of personal Quite often, patients are well aware of the dif-
goals into a rehabilitation programme improved Žculties 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 real-
prolonged 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 barri-
more efŽcient and effective Žtness training in ers of impairments and disabilities. These sub-
people with chronic airway limitation.34 Bauer jects require assistance in understanding the
and McBride suggested that a life goals group requirements to fulŽl their life goals, their cur-
psychotherapy programme was successful in the rent and likely future situation and possible alter-
treatment of bipolar affective disorders.35 natives. This realization often causes anxiety and
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 emo-
patients 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 beneŽts unachievable goals and a person’s idealized self-
of 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 signiŽ-
mood of the subjects.2 Evidence on the efŽcacy 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
rehabilitation programme is still lacking. domain.2 Schultze and Ososke suggested that
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 sugges-
available interventions, resources and environ- tion.39 ‘Validation’ is the acknowledgement of
ment, should assess the life goals obtained from difŽculties that the patient is facing in goal striv-
patients. Many of the life goals of clients may ing and normalizing the experience. ‘Compli-
turn 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 introduc-
goals. 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 behav-
cess 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 adjust- The rate of recovery from neurological disor-
ment 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 person-
ease, a lack of adjustment in expectations and life ally meaningful goals results in emotional dis-
goals led to difŽculty 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
Downloaded includ-
from http://cre.sagepub.com provision
at University of Hong Kong of expert
Libraries on July 1, information
2010 on prognosis and
 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 River-
Many subjects do not appreciate the signiŽ- mead Rehabilitation Centre, patients and family
cance of various therapies. They fail to link daily members are invited to participate in all goal-
treatment 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 bor-
life 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
Downloaded their life goals.at UniversityThe
http://cre.sagepub.com lifeLibraries
of Hong Kong goals expressed
on July 1, 2010 by the patients may
200 KP Sivaraman Nair
change during the course of a rehabilitation pro-
gramme. This may be due to two reasons. Dur-
ing the initial phases of rehabilitation it may be
difŽcult to get a true picture of what the patient
wants or is expecting from the team. Impaired
communication and cognitive deŽcits may inter-
fere 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 pro-
gramme for a while. The rehabilitation often
results in reduction in disabilities even though the
impairments may not change. The degree of inde-
pendence in activities of daily living and mobil-
ity 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 meet-
ings usually occur once in six weeks.
The role of the rehabilitation team with regard
to patients’ life goals include:
1) IdentiŽcation 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 unachiev-
able.
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 pro-
gramme 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 pro-
gramme.
The motivation of the patient to participate in
rehabilitation process may improve with these
steps.
Downloaded from http://cre.sagepub.com at University
Clinical messages
• Life goals are objectives that a person
strives to attain or avoid.
• They are hierarchically organized, accessi-
ble to conscious awareness and can be iden-
tiŽed.
• Life goals may inuence participation in
rehabilitation programme.
• It is not clear whether rehabilitation pro-
grammes focusing on life goals will improve
outcome.
Conclusions
Life goals are hierarchically organized and are
inuenced by various physical and psychological
factors. Illness and disabilities interfere with pur-
suit 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 reha-
bilitation setting. Incorporation of a subject’s life
goals into a management programme results in
better outcomes in various physical and psychi-
atric disorders. It is still not clear whether reha-
bilitation 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.
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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) My residential and domestic arrangements (where I live and who with) are : 0 1 2 3
2) My ability to manage my personal care (dressing, toilet, washing) is : 0 1 2 3
3) My leisure, hobbies and interests including pets are : 0 1 2 3
4) My work, paid or unpaid is : 0 1 2 3
5) My relationship with my partner (or my wish to have one) is : 0 1 2 3
6) My family life (including with those not living at home) is : 0 1 2 3
7) My contacts with friends, neighbours and acquaintances are : 0 1 2 3
8) My religion or life philosophy is : 0 1 2 3
9) My Žnancial status is : 0 1 2 3
Courtesy of Rivermead Rehabilitation Centre, Abingdon Road, Oxford, UK. Reproduce freely, but
acknowledge source and do not sell.

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