Setting goals in pediatric rehabilitation is important for children, families, therapists, and policy makers. It guides the therapy process and helps all involved conceptualize what will be done during the long process of rehabilitation. Having a priority list of functional goals according to diagnosis, functional level, and age, as presented in Rast et al.’s article, may direct management in their decisions about resources, staffing, and research. The authors identified walking short distances as the top goal of children in their rehabilitation centre. This may lead management to allocate an increase in physical therapy services in their facility. Rast et al. described the family-centred, goal setting process. This process is paramount and differs from past ‘paternalistic’ models where physicians and therapists defined therapeutic goals. However, in the current study it is not clear whether the children or the parents defined the goals and if they were actually achieved. Vroland-Nordstrand et al. compared outcome measures of child and parental goal setting-based therapy, showing that children’s selfidentified goals were attainable to the same extent as ones identified by their parents and remained stable over time. Costa et al. found differences in the goals defined by children, parents, and teachers. Children were more likely to identify independence in everyday activities and social participation, in contrast to their parents who identified school performance as most important and teachers who were concerned with body functions and school activities. Whenever possible, children should be the ones identifying their own therapeutic goals. As Rast et al. indicate, the International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework for rehabilitation that looks at all aspects of life, although they limited the choice of therapeutic goals to two categories: mobility and self-care. It is not clear whether these two areas were first identified as the primary choice for rehabilitation by the adults or if they were offered as the most frequent goal areas that should be worked on in rehabilitation. When asked, children identified goals in other areas such as leisure as their top priority compared to parents who identified daily activities as top priorities. Rosenbaum and Gorter converted the ICF model to a more appropriate framework for children using what they dubbed as the ‘F-words’: function, family, fitness, fun, friends, and future. It would have been interesting to compare how each goal would have been defined according to these ‘F-words’. Would walking still be the top goal? Or playing with friends or participating in recess? The study defined walking and moving, transportation, and changing and maintaining body position (i.e. sitting, standing) as 66% of all goals. As a society we emphasize walking, standing, and movement as a key goal. Many expressions and idioms use these words to project a societal ideal (‘stand up for yourself’, ‘stand tall’, ‘stand out’, ‘take a stand’, ‘walk the talk’, ‘step up’) and are used even when someone is not able to actually stand. Thus, from a very early age, children absorb the concept that they should aspire to ‘stand and step’. This, too, may influence how families define rehabilitation goals. The authors acknowledge two main limitations of their study. One is related to an essential bias of the frequency of ICF terminology as reflected by categories and subcategories. The second is related to the descriptive nature of the data which precludes an in-depth statistical analysis that in turn limits the use of predictive models as a means to help clinicians and family members make more concrete use of their results. Future studies addressing these are expected to strengthen the usefulness of the findings.

中文翻译：

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谁设定了儿科康复的目标？

设定儿科康复目标对儿童、家庭、治疗师和政策制定者都很重要。它指导治疗过程并帮助所有相关人员概念化在漫长的康复过程中将要做的事情。根据诊断、功能级别和年龄列出功能目标的优先级列表，如 Rast 等人的文章中所述，可以指导管理层做出有关资源、人员配备和研究的决策。作者将短距离步行确定为康复中心儿童的首要目标。这可能会导致管理层在其设施中增加物理治疗服务。拉斯特等人。描述了以家庭为中心的目标设定过程。这个过程是最重要的，与过去的“家长式”模式不同，后者由医生和治疗师定义治疗目标。然而，在目前的研究中，不清楚是孩子们还是父母定义了目标，以及这些目标是否真的实现了。Vroland-Nordstrand 等。比较了基于儿童和父母目标设定的治疗的结果测量，表明儿童自我确定的目标与父母确定的目标在相同程度上可以实现，并且随着时间的推移保持稳定。科斯塔等人。发现孩子、父母和老师定义的目标存在差异。与将学校表现视为最重要的父母和关注身体功能和学校活动的教师相比，儿童更有可能在日常活动和社会参与中确定独立性。只要有可能，儿童应该是确定自己治疗目标的人。正如 Rast 等人。表明，国际功能、残疾和健康分类 (ICF) 提供了一个全面的康复框架，该框架着眼于生活的各个方面，尽管它们将治疗目标的选择限制为两类：行动能力和自我保健。目前尚不清楚这两个领域是否首先被成人确定为康复的主要选择，或者它们是否被提供为最常见的康复目标领域。当被问到时，与将日常活动视为首要任务的父母相比，儿童将休闲等其他领域的目标列为首要任务。Rosenbaum 和 Gorter 将 ICF 模型转换为更适合儿童的框架，使用他们所谓的“F 字”：功能、家庭、健身、乐趣、朋友和未来。比较如何根据这些“F 字”定义每个目标会很有趣。步行仍然是首要目标吗？或者和朋友一起玩或者参加课间休息？该研究将步行和移动、运输以及改变和保持身体姿势（即坐、站）定义为所有目标的 66%。作为一个社会，我们强调步行、站立和运动是一个关键目标。许多表达和习语都使用这些词来表达社会理想（“为自己挺身而出”、“挺身而出”、“脱颖而出”、“站出来”、“言行一致”、“站出来”）并被使用即使有人无法真正站立。因此，从很小的时候，孩子们就接受了他们应该渴望“站立和迈步”的概念。这也可能影响家庭如何定义康复目标。作者承认他们的研究有两个主要局限性。一个与类别和子类别所反映的 ICF 术语频率的基本偏差有关。第二个与数据的描述性质有关，这妨碍了深入的统计分析，而这反过来又限制了预测模型作为帮助临床医生和家庭成员更具体地利用其结果的一种手段的使用。解决这些问题的未来研究有望加强研究结果的有用性。第二个与数据的描述性质有关，这妨碍了深入的统计分析，而这反过来又限制了预测模型作为帮助临床医生和家庭成员更具体地利用其结果的一种手段的使用。解决这些问题的未来研究有望加强研究结果的有用性。第二个与数据的描述性质有关，这妨碍了深入的统计分析，而这反过来又限制了预测模型作为帮助临床医生和家庭成员更具体地利用其结果的一种手段的使用。解决这些问题的未来研究有望加强研究结果的有用性。