You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Should patients participate in clinical decision making? An optimised balance block design controlled study of goal setting in a rehabilitation unit
Abstract 1:
Objectives : The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care . However , few protocol s exist to support this . One potentially useful method is goal setting , but little has been done to evaluate the added value of increasing patient participation in this way . Therefore , this study examined the impact of an increased participation goal setting protocol in a neurorehabilitation setting . Design : The study was an AB optimised balance block design with each block lasting 3 months , over an 18 month period . Setting and participants : Patients ( n = 201 ) were recruited from an inpatient neurological rehabilitation unit . Interventions : Patients ( n = 100 ) recruited in phase A were involved in “ usual practice ” goal setting .  Patients ( n = 101 ) recruited in phase B were involved in “ increased participation ” goal setting , which included a protocol to help them define and prioritise their own goals . Main outcome measures : Patients ’ perceptions of the relevance of goal setting and their autonomy within the process ; the number , type and outcome of goals ; and level of functional ability . Results : Phase B patients ( “ increased participation ” ) set fewer goals , of which significantly more were participation related . These patients perceived the goals to be more relevant , and expressed greater autonomy and satisfaction with goal setting . There were no differences in functional outcomes between the groups . Conclusion : This study has shown that patients prefer increased participation in the goal setting process over st and ard procedures , perceiving their goals as more relevant and rehabilitation more patient centred despite the absence of functional gains . Effective patient centred care can be realised by using structures that help support patients to identify and communicate their priorities . As such , our findings suggest patients would benefit from greater participation in this aspect of clinical decision making


Title 2:
The practical use of goal attainment scaling for people with acquired brain injury who receive cognitive rehabilitation
Abstract 2:
Objective : To examine the feasibility of and clinical experiences with goal attainment scaling when used for the evaluation of cognitive rehabilitation in people with acquired brain injury . Design : A prospect i ve observational longitudinal study . Setting : A 21-week cognitive rehabilitation programme and a cognitive programme with varying length in two different Dutch rehabilitation centres . Subjects : Forty-eight consecutive patients with acquired brain injury enrolled during a 15-month period . Interventions : Cognitive rehabilitation programme . Main measure : Goal attainment scaling ; the number of goals was counted ; time to set goals was recorded ; the number of different domains in which goals were set was counted ; goal attainment scaling score was calculated at baseline , one week after the end of the cognitive rehabilitation programme and at six months follow-up ; clinical experiences that could be useful for both clinical and research practice were recorded . Results : The mean ( SD ) age of the patients was 46.1 ( 10.7 ) years ; 29 ( 60 % ) were male ; 186 goals were set with a mean ( SD ) number of 4 ( 1 ) goals per patient . It was possible to set at least three realistic goals per patient within 30 minutes . Most goals were set in the cognitive domain ( i.e. memory and attention ) , followed by the behavioural domain ( i.e. fatigue and aggression ) . Conclusion : It proved possible to set three goals within an acceptable time-frame , to involve patients in the goal - setting procedure , to set realistic goals , and to set goals within relevant domains . Based on clinical experiences , goal attainment scaling is less feasible for research when patients lack insight , or suffer from comorbidity or mood problems


Title 3:
A pilot study of self-regulation informed goal setting in people with traumatic brain injury
Abstract 3:
Objective : To determine the acceptability and clinical application of two recently developed goal - setting interventions ( Goal Management Training and Identity Oriented Goal Training ) in people with traumatic brain injury . Design : A three parallel group , r and omized controlled pilot study . Setting : Inpatient and community rehabilitation facilities . Subjects : Thirty-four people with moderate to severe traumatic brain injury ( Goal Management Training , n = 12 ; Identity Oriented Goal Training , n = 10 ; usual care , n = 12 ) and their rehabilitation clinicians . Interventions : For both Goal Management Training and Identity Oriented Goal Training participants met face to face with their key worker weekly over a period of 6—8 weeks , during which time the key worker worked to engage them in goal setting and goal performance using the strategy prescribed by their group allocation . Usual care was provided to the other participants . Main measures : Largely qualitative using observation , individual interviews and focus groups . Participants also completed a Goal Attainment Scale at baseline , post intervention and at three months follow-up . Results : Both approaches were acceptable to the majority of participants with many reporting improved mood and goal attainment . Clinicians found working in a different way with patients both challenging and rewarding , with both experimental approaches enhancing a focus on the person 's own goals . Identity Oriented Goal Training seemed particularly helpful in engaging people in the goal - setting process while Goal Management Training appeared particularly helpful in providing a structured framework for error prevention in attempting goal performance . Conclusion : These theoretically informed approaches to goal setting showed promise but were time intensive and at times difficult for practitioners to utilize
Conclusion : The main barriers and facilitators to goal - setting during stroke rehabilitation have been identified .
They suggest that current methods of goal - setting during inpatient/early stage stroke or neurological rehabilitation are not fit for purpose