Goal Setting During Telerehabilitation in Japan: Qualitative Study of Occupational Therapists' and Physical Therapists' Experiences Using Reflexive Thematic Analysis.

Background: Telerehabilitation expanded rapidly during the COVID-19 pandemic and is increasingly used alongside, or as an alternative to, in-person rehabilitation. Goal setting is a core component of client-centered rehabilitation; however, how therapists conduct goal setting remotely remains poorly understood, particularly in East Asian contexts. To our knowledge, no qualitative study has specifically examined remote goal setting in telerehabilitation in Japan, where remote delivery was not yet routine when these data were collected. Objective: This qualitative study aimed to explore how Japanese occupational therapists and physical therapists experienced negotiating and adapting rehabilitation goals during telerehabilitation, including how remote delivery shaped assessment, collaboration, and the purposes assigned to goals. Methods: Individual semistructured interviews (18-51 minutes; mean 32 minutes) were conducted via Zoom (Zoom Communications, Inc) in Japanese with 9 therapists (7 occupational therapists and 2 physical therapists; 7 male and 2 female; aged 29-43 years) who had direct experience of remote goal setting. Participants were recruited by purposive and snowball sampling from 9 different workplaces across Japan, including metropolitan areas such as Tokyo and regional areas such as Hokkaido and Nagasaki, and worked in hospital, private-practice, community-based, and academic settings. Data were analyzed using reflexive thematic analysis within a contextualist epistemology, following Braun and Clarke. Trustworthiness was considered using Nowell and colleagues' criteria, and reporting followed the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Results: Four themes were constructed: (1) losing touch: uncertainty in remote assessment and goal setting (9/9 participants); (2) from direct intervention to coaching-oriented goal setting (8/9 participants); (3) at home, at ease: needs that surface in clients' own environments (6/9 participants); and (4) when continuity becomes the goal (6/9 participants). Therapists described remote goal setting as shaped by both constraint and possibility. Partial bodily, nonverbal, and contextual information reduced their confidence in assessment and goal negotiation, and they responded through preparation, visual resources, self-monitoring tools, and collaboration with clients and families. Sessions conducted in clients' own environments appeared to support comfort and sometimes made everyday needs more visible. When in-person care was unavailable or insufficient, therapists sometimes broadened goals from functional improvement alone to include continuity, ongoing monitoring, and prevention of disengagement. Conclusions: In these therapists' accounts, remote goal setting was not simply a diminished version of in-person practice but a distinct clinical process requiring deliberate preparation, collaborative communication, and management of uncertainty. Hybrid pathways may combine in-person assessment, when hands-on examination is needed, with continued remote negotiation, monitoring, and revision of goals. Further research should incorporate clients' and families' perspectives and evaluate hybrid models of goal setting across diverse rehabilitation populations.