Goal Setting in Rehabilitation

Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - Luisa Holt, Lauren Lopez, Kim Jackson, Tony Lowe, Naomi O'Reilly, Stacy Schiurring, Claire Knott, Amanda Ager, Tarina van der Stockt, Uchechukwu Chukwuemeka, Rucha Gadgil, Nicole Hills, Rishika Babburu, Admin and Simisola Ajeyalemi  

Introduction

Goal setting between physiotherapists and their patients or clients is a fundamental part of rehabilitation. Goal setting is “the formal process whereby a rehabilitation professional or team together with the patient and/or their family negotiate goals.” (Wade 2009 p291-292).  

Goal setting is used to direct rehabilitation interventions towards a specific outcome or outcomes.  Shared goal setting can also co-ordinate members of the multidisciplinary team and ensure they are working together towards a common goal and that nothing important is missed (Wade 2009). Goals can also be used to evaluate the success of rehabilitation interventions (Wade 2009). 

There is no consensus on a gold standard for a method of goal setting but it is widely held that it is a priority for guiding rehabilitation interventions toward achievable and meaningful outcomes3. There is a growing body of literature dedicated to the methods of and evidence for1,2(Bouwens) goal setting in rehabilitation. 

The Basics of Goal Setting

Goal setting is based on the belief that humans can change their behaviour and work towards a goal (Scobbie et al, 2009). 

Goal setting is important for rehabilitation because it can provide the patient with motivation (Wade 2009). A meaningful goal can motivate a patient to participate in rehabilitation in order to achieve their goals.  For example, the elderly patient in rehabilitation following a hip replacement who wants to return to living independently in their own home with their spouse. In order to do this, the patient needs to be independently mobile and therefore can see the importance of participating in physiotherapy. 

Goals can be thought of as hierarchical (Maslow). Maslow suggested that a person will make their physiological needs their primary goals. Once a person has met their physiological needs, he or she will make goals at the next level, safety and security, and so on. See Diagram One for all levels.     

 

   

Goal setting is also important as it keeps the focus of rehabilitation patient-centred. Goal setting helps health professionals plan their interventions for what is best or most meaningful for the patient instead of what suits the health professionals (where there are differences).  

Goals can be defined by time e.g. short, medium or long-term. In physiotherapy, goals are often activity based. For example, a patient being able to do a functional task independently or being able to walk a certain distance with the aid of walking frame. 

Goal Setting Methods

Goal setting is the process of discussing, planning and documenting outcomes for a patient. It can be as simple as a conversation between a physiotherapist and a patient during a treatment session. Or, in can be more complex and structured in a meeting between a multidisciplinary team and a patient. The patient’s social supports, e.g family members or friends, may also be invited to join in with goal setting if they have a role to play in helping the patient achieve a particular goal.  

One common method of goal setting has been derived from SMART goals. SMART goals originated in the field of project management (Doran 1970s). There are some variations but in general the acronym stands for: 

S   Specific 

M  Measurable 

A   Attainable or Assignable 

R   Realistic 

T   Time-related 

Another system which is grounded in rehabilitation research is the goal attainment scaling (GAS) by Lynne Turner-Stokes (2009). GAS is “a mathematical technique for quantifying the achievement of goals” (Turner-Stokes). GAS describes a process for setting goals and uses a five-point scale to measure how the goal is achieved or not. GAS scores can then be aggregated. Individual scores can be weighted to reflect either the relative importance of a goal to the patient or health professional or the difficulty in achieving the goal.

There are some factors which can facilitate or create barriers to successful goal setting. See Table One. 

Table One: Factors Influencing Goal Setting

Factor	Influence	Evidence
Time	Facilitator or barrier	Playford et al 2009
Social supports	Family and friends may help or hinder	Alanko et al 2018
Pain	Barrier	Alanko et al 2018
Health professionals’ expertise or lack of	Facilitator or barrier	Playford et al 2009
Cognition	Barrier	Bouwens et al, 2009
The patient’s self awareness	Facilitator or barrier	Fischer et al 2004
Patient involvement	Facilitator	Evans 2012
Patient’s desire to pursue goals and modify as needed	Facilitator	Coffey et al 2014

Evidence For Goal Setting

Author	Date	Population	n=	Intervention	Outcome Measure	Main Results
Bouwens et al	2009	Acquired brain injury	48	Cognitive rehabilitation programme	Goal Attainment Scaling, number of goals made, time to set goals, domains in which goals were set	It is possible to set three realistic goals per patient withing 30 minutes. Goals were set in cognitive and behavioural domains
Rosewilliam et al	2011	Stroke	Not applicable	Systematic review of 18 qualitative studies, eight quantitative studies and one mixed methods study	Not applicable	Nominal adoption of goals setting, discrepancies between perceptions and practice of goal setting, related ethical conflicts, strategies to improve goal setting, weak methodologies, some improvement in psychological outcomes, further research needed.
Coffey et al	2014	Lower limb amputation	64	Not applicable	WHODAS 2.0, WHO-QOL-BREF,  Tenacious Goal Pursuit Scale, Flexible Goal Adjustment Scale	High levels of disability in this population. QoL stable over first six months. Stronger goal pursuit and goal adjustment tendencies predicted lower disability and higher QoL six months post discharge
Alanko et al	2018	Stroke and back pain	20	Not applicable	Qualitative  interviews and analysis of rehabilitees perspectives on goal setting in rehabilitation	Five meanings:  1) “trust in the rehabilitation situation, professionals, oneself and relatives”  2) “respectful presence”  3) “confusing awareness”  4) “disturbing pain”  5) “fear of unpredictability”

Practical Points to Remember

• Use goals to guide and evaluate your physiotherapy treatments. 
• Discuss, plan and review goals for rehabilitation with your patient. 
• Discuss, plan and review goals for rehabilitation with other members of your multidisciplinary team (if applicable). 
• Use a method such as SMART or GAS and document the goals made with a date to review them and check for progress. 

Related Physiopedia Pages

Rehabilitation

Multidisciplinary/interdisciplinary management of the amputee

Re-engagement in Life Roles with Pain Conditions

Resources

• bulleted list
• x

or

1. numbered list
2. x