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Background.: Five stroke rehabilitation teams were supported in the implementation of Cognitive Orientation to daily Occupational Performance (CO-OP) as part of a knowledge translation (KT) project called CO-OP KT. Medical record auditors noted there was occasionally a disconnect between client goals and treatment plans, revealing a need to better understand the characteristics of each and their relationship to each other., Purpose.: This study aimed to examine the characteristics of goals and treatment plans in occupational therapy before and after CO-OP KT., Method.: A descriptive secondary analysis of medical record data was employed., Findings.: Post intervention, there was a change in goal specificity ( p = .04) and therapist-client goal alignment ( p = .05). Occupation-based goals were often paired with a bottom-up, impairment-based treatment. Top-down treatments, when present, lacked the same detail given to bottom-up plans., Implications.: CO-OP KT seemed to lead to more specific goals, but matching top-down treatment plans were not found.

For individuals with brain injury, active participation in goal setting is associated with better rehabilitation outcomes. However, clinicians report difficulty engaging these clients in goal setting due to perceived or real deficits (e.g., lack of awareness). We conducted a study using grounded theory methods to understand how clinicians from occupational therapy facilitate client engagement and manage challenges inherent in goal setting with this population. Through constant comparative analysis, a goal-setting continuum emerged. At one end of the continuum, therapists embrace client-determined goals and enable clients to decide their own goals. At the other, therapists accept preset organization-determined goals (e.g., "the goal is discharge") and pay little attention to client input. Although all participants aspired to embrace client-determined goal setting, most felt powerless to do so within perceived organizational constraints. Views of advocacy and empowerment help to explain our findings and inform more inclusive practice., (© The Author(s) 2015.)