Goal Setting According to Level of Mobility Independence in Home-Visit Rehabilitation Using Canadian Occupational Performance Measure

ABSTRACT

Objectives:

This study aimed to clarify the differences in goal setting and achievement trends in home-visit rehabilitation at different levels of independence in mobility.

Methods:

Goals set at the beginning of home-visit rehabilitation were retrospectively examined using the Canadian Occupational Performance Measure (COPM). All goals were classified into nine categories in three domains based on the principles of the COPM. The participants were divided into three groups according to their level of independence in mobility. The proportion of participants with goals in each category was compared. Additionally, the COPM performance and satisfaction scores at the beginning of rehabilitation and 3 months later were compared.

Results:

In total, 245 participants were categorized into the assisted (n=48), supervised (n=65), and independent groups (n=132). Functional mobility (36.3%) was the most common goal, accounting for the largest number of patients within each group. The percentages of those with goals in the categories of personal care (P = 0.013), community management (P < 0.001), household management (P < 0.001), quiet recreation (P < 0.001), and active recreation (P = 0.024) were significantly different among the three groups. All three groups showed significant improvements in performance scores (assisted group, P = 0.014; supervised group, P < 0.001; independent group, P < 0.001) and satisfaction scores (P < 0.001 in all three groups) in the self-care domain.

Conclusions:

Goal categories for home-visit rehabilitation varied according to the level of independence in mobility. Nevertheless, goals in the self-care domain are likely to be achieved, regardless of mobility independence, after home-visit rehabilitation.

INTRODUCTION

Home-visit rehabilitation is a supportive tool for continuing daily life and caregiving in a familiar living environment. Typically, personalized rehabilitation is provided by physical, occupational, and speech therapists who visit patients’ homes. Home-visit rehabilitation aims to reestablish daily activities, improve the quality of life, reduce the burden of care, and assist patients with what they desire to do.¹⁾ Previous studies have reported that home-visit rehabilitation improves motor function, basic activities of daily living (ADL), and instrumental ADL and reduces the burden of caregiving.^2,3,4,5,6)

In Japan, home-visit rehabilitation is covered by the national long-term care insurance system, which is widely provided to patients with various diseases and conditions,^7,8) with the most important objective of improving their independence in daily living at home.⁹⁾ However, under the insurance system, the time for therapist visits is usually limited to 40–60 min per day, approximately twice a week. Therefore, it is recommended that the activities to be targeted for intervention should be clarified, and appropriate goals should be set for the realization of activities to make the intervention maximally effective.¹⁰⁾

In setting rehabilitation goals, effectiveness can be enhanced when patients themselves are involved in the goal-setting process to make the goals specific.^11,12) One well-known method for setting goals in rehabilitation is the Canadian Occupational Performance Measure (COPM).¹³⁾ Using this tool, the evaluator interviews the client and systematically lists the occupational tasks in their current daily lives to determine the most important items as rehabilitation goals. The use of the COPM facilitates patient involvement in the goal-setting process, thereby increasing the effectiveness of rehabilitative intervention.^14,15,16,17) Additionally, the COPM has been reported to be useful for evaluating the effectiveness of rehabilitation.^17,18) The benefits of implementing COPM in community-dwelling older adults have also been demonstrated.¹⁹⁾ However, the application of any systematic goal-setting process, such as the COPM, in clinical settings of home-visit rehabilitation, which includes populations with various diseases or disabilities and higher needs of care, has not been reported. Clarifying the details of individualized goals for people with disabilities requiring care is useful in standardizing the quality of home-visit rehabilitation. In particular, it would be of great clinical importance to clarify differences in goal setting according to mobility, because life-space mobility is known to influence various aspects of life in the older population.²⁰⁾ Moreover, to optimize home-visit rehabilitation strategies, it is essential to know the status of goal achievement.

This study aimed to clarify goals and achievements according to the characteristics of home-visit rehabilitation users. Specifically, we aimed to verify whether there were differences in the details and accomplishment status of established goals according to the level of independence in mobility.

MATERIALS AND METHODS

Study Design and Participants

This retrospective study was conducted after the protocol was approved by the Institutional Ethics Committee of the National Center for Geriatrics and Gerontology (No.1582–2). Patients provided with home-visit rehabilitation by the National Center for Geriatrics and Gerontology for at least 3 months between June 2016 and June 2022 were included as participants. This population included those who started home-visit rehabilitation upon request during the community-based phase and those who started the service immediately after discharge from hospital settings, such as convalescent rehabilitation wards, community-based integrated care wards, or acute medical wards. The basic information, rehabilitation goals determined using the COPM, baseline COPM assessment scores at the initiation of home-visit rehabilitation, and follow-up COPM assessment scores 3 months after initiation were extracted from medical records. Potential participants who could not be fully evaluated using the COPM because of severe cognitive dysfunction were excluded from the study. Opt-out consent was adopted as the procedure for informed consent, wherein the study protocol was disclosed via the hospital’s website and posters within the hospital, providing the relevant patients with the opportunity to refuse participation.

COPM Assessment

The COPM was administered through a semi-structured interview designed to detect a person’s perception of occupational performance.¹³⁾ According to the standardized assessment process for the COPM, the five most important problems were selected as the rehabilitation goals through prioritizing occupational issues in the individual’s daily life. These goals were determined at the beginning of home-visit rehabilitation. For those who had difficulty expressing specific goals because of cognitive decline or aphasia, family members, as primary caregivers, helped identify the desired goals. In such cases, agreement was obtained from the individual wherever possible after discussing goals with family members. Additionally, goals regarding the reduction of caregiver burden were also allowed from the perspective that they benefit the individuals receiving care.

The conceptual framework of COPM is summarized in the Canadian Model of Occupational Performance and Engagement (CMOP).²¹⁾ This framework classifies the “occupation,” which represents every activity performed by the person, into three domains: 1) self-care, the minimal everyday tasks for living; 2) productivity, tasks performed as a social duty or contribution; and 3) leisure, tasks performed as a hobby or for pleasure. More specifically, the domain of self-care includes personal care (dressing, bathing, feeding, hygiene), functional mobility (transfers, indoor mobility, outdoor mobility), and community management (using transportation, shopping, financial management); the domain of productivity includes paid/unpaid work, household management (cleaning, laundry, cooking), play/school; and the domain of leisure includes quiet recreation (crafts, reading), active recreation (sports, outings, travel), and socialization (visiting, phone calls, parties). However, at the point when the individuals receiving home-visit rehabilitation set their five goals, the category within the COPM framework to which the goals corresponded had not been determined. Therefore, all the goals were retrospectively classified into one of the nine categories in the COPM. Goals related to diseases or disabilities were discussed individually to determine suitable categories according to intentions. Specifically, management of the affected limb was categorized as personal care, whereas goals related to fall prevention were categorized as functional mobility. The goal associated with the practice of self-training was categorized as personal care if it was intended to maintain physical function, including swallowing, or to improve independence in basic ADLs, whereas it was categorized as active recreation if it was set to realize the desire to walk freely. Goals related to the use of long-term care insurance services were categorized based on their primary purpose: attending daycare services to interact with others was classified as socialization, and doing tasks or handcrafts in daycare services was classified as quiet recreation. Two researchers (RN and SK) performed the classification independently, and disagreements were discussed until a consensus was reached or resolved by the other researchers (EO and KS).

The participants rated their status of performance and satisfaction using a 10-point scale for each of the five goals listed. These items, COPM performance scores and satisfaction scores, were obtained at the beginning and 3 months after the start of home-visit rehabilitation.

Assessment of Functional Independence Measure

The Functional Independence Measure (FIM) was used to assess functional independence at the beginning of the home-visit rehabilitation. The FIM comprises 13 motor subscales and 5 cognitive subscales. Each of the 18 items is rated on a 7-point ordinal scale from 1 (totally dependent) to 7 (completely independent), resulting in a total score ranging from 18 to 126.²²⁾ Multiple studies have demonstrated the reliability and validity of the Japanese version of FIM.^23,24) Based on the score for the item of mobility (walking and wheelchair), participants were divided into three groups: assisted group with a score of 4 or less (requiring assistance), supervised group with a score of 5 (requiring supervision), and independent group with a score of 6 or 7 (completely independent or independent in using assistive devices). The distinction was not made as to whether the means of transportation was walking or use of a wheelchair; therefore, those who used wheelchairs daily were included in each group.

Home-visit Rehabilitation

Individualized home-visit rehabilitation programs were provided to all the participants. Physical, occupational, or speech therapists provided one or two sessions per week on average (40–60 min/session), and these were structured to efficiently achieve goals determined using the COPM. Each program invariably comprised practice of ADL in real-life environment, recommendation for walking aids and assistive devices, guidance on daily exercise and daily physical activity, support for caregivers, support for enhancing participation, and multidisciplinary cooperation (Table 1). The proportion of time spent on each item was varied according to the individual characteristics and needs of the patient.

Table 1.  Basic structure of home-visit rehabilitation program.

Item	Examples
Practice of ADL in real-life environment	-Repetitive practice of movements in basic ADL, such as transfer, moving in the home environment, climbing stairs, and bathing, while under the supervision and guidance of therapists. -Planning and practicing instrumental ADL, such as cooking or meal preparation, dishwashing, laundry, housework, and shopping.
Recommendation for walking aids and assistive devices	-Suggestions for eliminating environmental hazards and enhancing independence by using assistive devices such as handrails, nursing beds, slopes, and instruments for bathroom, including home modifications. -Selections of appropriate walking aids for indoors and outdoors in consideration of in-home and regional environment.
Guidance on daily exercise and daily physical activity	-Provision of an exercise program to be practiced daily including resistance training, aerobic exercise, and balance exercise appropriate to the person’s ability. -Advice on how to maintain and promote their daily physical activity.
Support for caregivers	-Assessment regarding the amount of assistance and the caregiver burden. -Hands-on practice with better ways of assistance in transferring, dressing, or bathing.
Support for enhancing participation	-Encouraging reengagement in activities such as participation in domestic activities and social interaction through motivational interviewing. -Helping set the next rehabilitation goals.
Multidisciplinary cooperation	-Sharing information regarding activities gained through rehabilitation with care managers and care staff. -Proposal for day care services or other activities to maintain physical function and ADL.

Statistical Analysis

The Kruskal–Wallis rank test with Dunn’s post-hoc test or Pearson’s chi-squared test was used to compare the basic characteristics between the three groups. In analyzing the categories of the participants’ goals, if the five goals listed by a person included at least one goal related to personal care, that person was classified as having a goal within the category of personal care. The same procedure was applied to all nine activity categories (personal care, mobility, community management, paid/unpaid work, household arrangement, play/school, quiet recreation, active recreation, and socialization). The percentage of participants with goals in each of the nine activity categories was calculated to explore the association between independence in mobility and COPM goal content. These percentages were compared using Pearson’s chi-squared test with post-hoc Pearson’s chi-squared test with Bonferroni correction, in which Pvalues were multiplied by the number of tests.

The performance and satisfaction scores at the start and 3 months later for each of the three domains of the CMOP (self-care, productivity, and leisure) were compared across groups according to mobility independence (assisted, supervised, and independent groups) using Wilcoxon’s signed rank test. Furthermore, to confirm the impact of mobility independence on goal achievement, multiple regression analyses were conducted with the performance scores and the satisfaction scores as dependent variables. All statistical analyses were performed using SPSS version 29 (IBM, Armonk, NY, USA) and StataNow/SE version 19.5 (StataCorp, College Station, TX, USA). Statistical significance was set at P < 0.05.

RESULTS

In total, 245 participants with 1218 goals were included in the analysis, excluding 7 goals that were changed within 3 months because the difficulty was not appropriate. Around 80% of the participants started home-visit rehabilitation immediately after discharge from a convalescent rehabilitation ward or a community-based integrated care ward. Those who started the service after discharge from an acute medical ward and those in the community-based phase were also included, although the number of these participants was relatively small. The basic characteristics of participants are listed in Table 2. No significant differences were found in age, sex, or primary diagnosis between the groups. The independent group had significantly higher scores on the subtotal of the FIM motor score, as well as the score for the item of mobility alone (independent group vs. supervised group, P <0.001; independent group vs. assisted group, P < 0.001; supervised group vs. assisted group, P < 0.001). Cognitive assessment scores were significantly higher in the independent group than those in the other two groups [subtotal FIM cognitive score: independent group vs. supervised group, P < 0.001; independent group vs. assisted group, P < 0.001; supervised group vs. assisted group, P = 1.000; Japanese version of Mini-Mental State Examination (MMSE-J): independent group vs. supervised group, P < 0.001; independent group vs. assisted group, P < 0.001; supervised group vs. assisted group, P = 0.679].

Table 2.  Baseline characteristics of study participants.

	Assisted group (n=48)	Supervised group (n=65)	Independent group (n=132)	P value
Age, years	82.5 [75–89]	85 [76–91]	82 [74–86]	0.137
Male	21 (43.8)	32 (49.2)	63 (47.7)	0.840
Primary diagnosis				0.718
Cerebrovascular disease	25 (52.1)	29 (44.6)	52 (39.4)
Musculoskeletal disease	17 (35.4)	27 (41.5)	61 (46.2)
Neurological disease	2 (4.2)	3 (6.3)	7 (5.3)
Other	4 (8.3)	6 (9.2)	12 (9.1)
Wheelchair users	32 (66.7) a	6 (9.2)	6 (4.5)	<0.001
FIM
Total score	67 [54–84]	94 [85–102] b	115 [109–119] c	<0.001
Mobility (walk/wheelchair) item	1 [1–2]	5 [5] b	6 [6–7] c	<0.001
Subtotal score of motor items	41.5 [30–57]	67 [61–73] b	82 [77–87] c	<0.001
Subtotal score of cognitive items	26.5 [21–32]	27 [24–30]	33 [30–35] c	<0.001
MMSE-J	26 [19–28]	23 [19–27]	28 [26–29] c	<0.001

Data provided as median [interquartile range] or number (percentage).

^a P < 0.001 compared with the other two groups (supervised and independent group) in post-hoc tests. ^b P < 0.001 compared with the assisted group in post-hoc tests. ^c P < 0.001 compared with the other two groups (assisted and supervised group) in post-hoc tests.

The categories of participant goals were as follows: personal care, 20.7%; functional mobility, 36.3%; community management, 7.5%; paid/unpaid work, 1.1%; household management, 12.9%; play/school, 0%; quiet recreation, 4.9%; active recreation, 11.8%; and socialization, 4.9%. Functional mobility was the most frequently selected of the nine categories.

The percentage of participants with goals in the personal care category differed significantly between the groups, with a higher percentage in the assisted group than that in the independent group in the post-hoc test (assisted group: 81.3% vs. independent group: 58.3%, P = 0.015) (Fig. 1). No significant differences were observed among the three groups in terms of functional mobility, which was the most frequently selected category within each group (assisted group, 87.5%; supervised group, 84.6%; independent group, 81.1%; P = 0.559). Specifically, the goals in the assisted group included the acquisition of the ability to transfer to a chair, the acquisition of usage of a transfer board, the acquisition of mobility independence in a wheelchair, and the acquisition of the ability to ascend steps at the entrance of the home. In contrast, the goals in the supervised group included improvements in mobility independence and the acquisition or improvement of the ability to ascend steps. The goals in the independent group included walking without aid, walking outdoors to a specific destination, and improving the ability to ascend steps outside the home.

Fig. 1.

 Percentage of participants having goals in each category in COPM. The y-axis represents the percentage of participants. A, assisted group; S, supervised group; I, independent group.

In the community management category, there was a significant difference among the three groups, with a higher percentage in the independent group than in the assisted group (10.4% vs. 40.9%, P < 0.001). Similarly, regarding household management, the supervised and independent groups showed significantly higher percentages than that in the assisted group (assisted group, 14.6%; supervised group, 35.4%; independent group, 56.1%; assisted group vs. supervised group P = 0.039, assisted group vs. independent group P < 0.001, supervised group vs. independent group P = 0.018).

Quiet recreation was significantly less common in the independent group (assisted group, 35.4%; supervised group, 30.8%; independent group, 12.1%; assisted group vs. independent group P < 0.001, supervised group vs. independent group P = 0.003), whereas active recreation was significantly more common in the independent group (assisted group, 25.0% vs. independent group, 47.0%; P = 0.024).

Regarding the changes in COPM performance and satisfaction scores 3 months after baseline across all participants, performance scores significantly improved in the categories of personal care (251 goals, baseline 5.5±3.1 vs. 3 months 6.7±3.0, P < 0.001), functional mobility (441 goals, baseline 5.6±2.8 vs. 3 months 6.5±2.9, P < 0.001), community management (92 goals, baseline 4.2±3.1 vs. 3 months 6.0±3.5, P < 0.001), and household management (158 goals, baseline 5.1±2.9 vs. 3 months 6.3±3.3, P < 0.001). Similarly, satisfaction scores significantly improved in the categories of personal care (251 goals, baseline 5.3±3.2 vs. 3 months 6.7±3.0, P < 0.001), functional mobility (441 goals, baseline 5.4±3.0 vs. 3 months 6.3±3.0, P < 0.001), community management (92 goals, baseline 4.2±3.3 vs. 3 months 6.2±3.6, P < 0.001), household management (158 goals, baseline 5.1±3.0 vs. 3 months 6.3±3.2, P < 0.001), and socialization (60 goals, baseline 3.4±3.1 vs. 3 months 5.0±3.6, P < 0.001).

Changes by group according to mobility independence level are summarized in Table 3. All three groups demonstrated significant improvements in both performance and satisfaction scores in the self-care domain. In contrast, the assisted and supervised groups showed no significant improvement in scores in the domains of productivity and leisure. In the independent group, significant improvements were observed in scores in these domains. Focusing on the functional mobility category, which had the highest goal-setting rate across all groups, significant improvements were observed in the performance score for all three groups [assisted group (108 goals), baseline 4.7±2.9 vs. 3 months 5.3±3.1, P = 0.040; supervised group (118 goals), baseline 6.0±2.5 vs. 3 months 6.9±2.5, P < 0.001; independent group (215 goals), baseline 5.9±2.8 vs. 3 months 6.9±2.8, P < 0.001]. Similarly, the satisfaction score was significantly improved for all three groups [assisted group (108 goals), baseline 4.5±2.7 vs. 3 months 5.3±3.2, P = 0.006; supervised group (118 goals), baseline 5.6±2.7 vs. 3 months 6.6±2.8, P < 0.001; independent group (215 goals), baseline 5.7±3.1 vs. 3 months 6.6±2.9, P < 0.001].

Table 3.  Changes from baseline in COPM performance and satisfaction scores after 3 months.

Domain	Assisted group				Supervised group				Independent group
	Baseline	3 months	P value		Baseline	3 months	P value		Baseline	3 months	P value
Self-care	(Total 180 goals)				(Total 216 goals)				(Total 388 goals)
Performance score	4.8±3.0	5.4±3.1	0.014		5.8±2.7	6.8±2.9	<0.001		5.5±3.1	6.9±2.9	<0.001
Satisfaction score	4.6±2.9	5.4±3.2	<0.001		5.5±2.9	6.6±2.9	<0.001		5.4±3.3	6.8±3.0	<0.001
Productivity	(Total 13 goals)				(Total 34 goals)				(Total 124 goals)
Performance score	5.2±3.6	4.8±3.4	0.688		4.6±3.0	4.8±3.3	0.730		5.0±2.9	6.7±3.2	<0.001
Satisfaction score	5.2±3.4	5.2±3.3	0.908		4.5±3.0	5.1±3.4	0.253		5.1±3.0	6.7±3.1	<0.001
Leisure	(Total 40 goals)				(Total 75 goals)				(Total 148 goals)
Performance score	3.6±3.2	4.0±3.3	0.350		4.4±3.5	4.4±3.5	0.558		3.9±3.1	4.5±3.2	0.038
Satisfaction score	3.5±3.2	4.1±3.2	0.475		4.3±3.6	4.9±3.5	0.504		3.9±3.3	4.6±3.3	0.014

Data are provided as mean ± standard deviation.

After adjusting for age, MMSE-J, and the COPM domain, the higher score of FIM mobility as an independent variable was significantly but weakly associated with an increase of COPM performance score (coefficient=0.19, 95% confidence interval: 0.09 to 0.30, P < 0.001) and COPM satisfaction score (coefficient=0.13, 95% confidence interval: 0.02 to 0.25, P = 0.022). Age, MMSE-J, and the COPM domain were not significant as explanatory variables.

DISCUSSION

This study investigated the status of occupational goals and achievements in people requiring care and who underwent home-visit rehabilitation. When examined according to the level of independence in mobility, a higher percentage of the assisted group had goals related to personal care and quiet recreation. Conversely, the independent group tended to have goals in community management, household management, and active recreation. Functional mobility was the most frequently listed category, regardless of mobility independence level.

The results showed that goals have different trends according to the level of mobility independence in a population undergoing home-visit rehabilitation. Concerning the difficulty of goals, a previous study using the Rasch model indicated that personal care is a relatively easy ADL compared to housework, which is considered a more demanding ADL.²⁵⁾ Therefore, the results of the present study suggest that the assisted group had goals with relatively lower difficulty, whereas the goals in the independent group were relatively more difficult tasks, indicating that the goals were appropriately designed according to the attributes and abilities of the participants. Particularly in the independent group, a larger number of goals fell into the categories of community management and household management, which are more complex and highly social tasks. This may reflect that this group tended to have higher cognitive function than the other groups in addition to higher mobility independence.

Notably, the percentage of those who listed goals regarding functional mobility was the highest in each group, although the details varied according to the level of independence. Life-space mobility has been noted as an important factor in interventions to improve ADLs because of its impact on ADLs and quality of life.²⁶⁾ Therefore, improving mobility is essential for home-visit rehabilitation regardless of the level of independence. Given these findings, the provision of rehabilitative interventions and instructions to improve functional mobility should be emphasized in home-visit rehabilitation.

This study investigated the achievement of occupational goals after 3 months of home-visit rehabilitation. The results suggest that in the self-care domain, the perceived degree of performance and satisfaction with targeted activities improved, regardless of the level of independence in mobility. Home-visit rehabilitation enables suggestions for appropriate assistive devices and repetitive ADL practice in an actual living environment, which effectively improves ADLs.²⁾ Therefore, it may have led to a subsequent improvement in both performance and satisfaction. Notably, the results showed that the goals in the functional mobility category can be achieved regardless of the mobility independence. This may be attributable to the appropriate goal setting commensurate with the individual’s ability, as indicated by the differences in the specific goals for each level of independence described in the results.

In the domain of productivity and leisure, improvement in targeted activities was not apparent in the assisted and supervised groups after 3 months. This may be related to the relatively small number of goals in these two domains in these two groups or the difficulty of expanding the activities on their own, owing to external factors, such as the need for accompaniment by caregivers. Although it is difficult to improve the physical function primarily by home-visit rehabilitation for older people with disabilities,²⁷⁾ the establishment of activities in daily life can lead to changes in ADL performance and physical function over the course of 6 months or on a yearly basis.²⁸⁾ Tuntland et al.¹⁹⁾ reported that home-visit rehabilitation for older people with disabilities did not show sufficient improvement in COPM at 3 months after initiation, but achieved improvement in both COPM performance and satisfaction scores at 9 months. Therefore, continued intervention and tracking over a longer period may lead to improved performance and satisfaction in the assisted and supervised groups. In the independent group, improved performance and satisfaction were observed in all three domains. Additionally, the higher score of FIM mobility was found to be associated with an increase of COPM scores representing goal achievement. These results are convincing, given that higher basic ADL is a key factor associated with instrumental ADL performance and participation in the home and community.²⁹⁾ Given that leisure activities in older people have been noted to reduce ADL and cognitive decline,³⁰⁾ utilizing COPM to acquire such leisure activities is of great importance.

This study had several limitations. First, the data were obtained from a single facility and the majority of participants in this study were provided home-visit rehabilitation immediately after discharge from rehabilitation wards, which is the phase of re-adapting to a daily life at home. Therefore, the findings should be generalized with caution to other facilities and regions. Differences may exist in the trend of goal setting or goal achievement in cases where home-visit rehabilitation is started in the community-based phase, that is, where the need for rehabilitation arose because of a gradual decline in ADL within the context of daily life at home. In particular, goal achievement could be relatively more difficult under the circumstances of functional decline in the community-based phase. Second, although the basic structure of the home-visit rehabilitation program was the same for all participants, its content was highly individualized and varied in terms of time allocation and instructions. Therefore, the relationship between the specific intervention and the achievement of goals should be clarified through different study designs. Third, as a retrospective study, a single-group pre–post comparison design was adopted to examine the goal-attainment status. To demonstrate the effectiveness of home-visit rehabilitation more clearly, a prospective intervention study should be conducted with a control group without home-visit rehabilitation.

Despite these limitations, the results of this study are clinically meaningful in that the characteristics of goals and their achievement status in home-visit rehabilitation were clarified using COPM according to mobility independence. When implementing home-visit rehabilitation, clinicians should support appropriate goal setting and achievement by considering the patient’s ability, as indicated in this study. Future research should explore the relationship between specific interventions practiced in home-visit rehabilitation and long-term goal attainment, thereby contributing to the establishment of more effective home-visit rehabilitation strategies.