Goal Setting During Telerehabilitation in Japan: Qualitative Study of Occupational Therapists' and Physical Therapists' Experiences Using Reflexive Thematic Analysis.
Yuho Okita, Kounosuke Tomori, Minoru Okita
PMID 42627961WHAT IT FOUND
Nine Japanese therapists described remote goal setting as a distinct practice, not a lesser one: they lost touch and whole-body observation but gained coaching roles, home visibility, and continuity as a goal.
Structure remote sessions around what you cannot do, not just what you can.
Key findings
01All 9 therapists reported that the inability to physically touch clients and the reduced access to nonverbal and contextual information limited their confidence in understanding clients' conditions and priorities. They experienced this not as mere practical inconvenience but as a disruption to their professional certainty in clinical judgment.
02Eight of the 9 therapists described shifting from direct hands-on intervention to a coaching role, using self-monitoring tools such as pedometers and check sheets, visual slide summaries, and family involvement to support goal setting between sessions. Several valued these adaptations not just as substitutes for in-person methods but as improvements in their own right.
03Six of the 9 therapists described how sessions conducted in clients' own living environments made everyday needs more visible and clients more at ease, while a further 6 described reorienting rehabilitation goals away from functional improvement alone toward maintaining continuity, ongoing monitoring, and sustained therapeutic connection.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only 9 therapists participated, with 7 occupational therapists and 2 physical therapists, and 7 men and 2 women, so the perspectives of PTs and female therapists are less fully represented. Findings are based on retrospective self-report in interviews, not on observation of actual remote sessions. Session frequency and duration were not collected systematically, so no comparison with in-person service schedules is possible. All participants had some telerehabilitation experience, which may limit transferability to therapists without such experience. The study did not include clients' or families' perspectives, so it captures only the therapist's side of goal setting. Data were collected during the COVID-19 pandemic, so some findings may reflect pandemic-related service disruption rather than enduring features of telerehabilitation. The study was conducted in Japan, where telerehabilitation was not yet routine and was often delivered outside standard reimbursement schemes; findings may not transfer to settings where remote practice is normalized.
Declared interests
Funded by JSPS KAKENHI (grant JP23K18374). No conflicts of interest declared.
The easy way to misread this
Do not read these themes as evidence that telerehabilitation improves or worsens patient outcomes. This is a qualitative study of 9 therapists' experiences in Japan during the pandemic, not an evaluation of treatment effects. The themes describe how therapists adapted their practice and what they found difficult or useful; they do not tell you whether your patients will do better or worse with remote goal setting, and the small, single-country, pandemic-era sample limits how far you can generalize.