Table 2 An outline of the questions that will be asked in the initial goal-setting conversation a few days after admission, in the goal-setting conversation at discharge, and in the four follow-up telephone calls

1

In this conversation we will try to agree on some goals for your rehabilitation stay. These should be based on what is important to you now and what you would like to change in your life, and they will be used to help you navigate during your stay and in your everyday life at home after discharge. So, could you tell me what thoughts you have concerning your long-term goals?

2

What would be important short-term goals to work on during your rehabilitation stay?

Discharge

1

Let’s start with a brief look back. Is there anything you experienced or gained during your stay that has been particularly important to you?

2

What thoughts do you have about what should be your long-term goals now?

3

What will be your specific short-term goals? What will you do day by day and week by week to achieve your long-term goals?

4

And specifically, what will you do next week?

5

And tomorrow?

First telephone follow-up

1

How are you?

2

Are there any specific challenges or issues you would like to discuss?

3

What are your most important goals now?

4

Could you please tell me a little about your plans for achieving those goals?

Second telephone follow-up

Same questions as in the first telephone follow-up call, with the following additional question:

5

Are there any other issues you’d like to discuss or new goals you’d like to pursue?

Third telephone follow-up

Same questions as in the second telephone follow-up call.

Fourth telephone follow-up

Same questions as in the second and third telephone follow-up, with the following additional question:

6

This is the last time I'll call you. Is there anything else you would like to add or discuss before we finish?