Cited by 754Medical Practices and RehabilitationOccupational Therapy Practice and ResearchStroke Rehabilitation and Recovery

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Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide

Bovend'Eerdt, Thamar JH, Botell, Rachel E, Wade, Derick T·2009·Clinical Rehabilitation

DOI 10.1177/0269215508101741

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Abstract

Objective: To describe a practical method of setting personalized but specific goals in rehabilitation that also facilitates the use of goal attainment scaling. Background: Rehabilitation is a complex intervention requiring coordinated actions by a team, a process that depends upon setting interdisciplinary goals that are specific, clear and personal to the patient. Goal setting can take much time and still be vague. A practical and standardized method is needed for being specific. Method: A novel approach to writing specific, measurable, achievable, realistic/ relevant and timed (SMART) goals is developed here. Each goal can be built up by using up to four parts: the target activity, the support needed, quantification of performance and the time period to achieve the desired state. This method can be employed as part of goal attainment scaling and the other levels can be easily and quickly formulated by adding, deleting and/or changing one or more of the (sub)parts. Discussion: The success of goal setting and goal attainment scaling depends on the formulation of the goals. The method described here is a useful tool to standardize the writing of goals in rehabilitation. It saves time and simplifies the construction of goals that are sufficiently specific to be measurable.

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“La rédaction d’une échelle GAS doit répondre à une série de règles construites au fur et à mesure de la recherche utilisant la GAS [7,24,26,27] :”
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“*SMART (specific, measurable, achievable, realistic, and timed) framework described by Bovend’Eerdt et al (51)”
Method
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“Several studies in the field of adult rehabilitation care in different settings and diagnostic groups have reported Goal Attainment Scaling to be useful for functional outcome measurement.(4,11,13,14,20) Studies in neurorehabilitation comparing Goal Attainment Scaling and the Functional Independent/ Assessment Measure…”
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Exercise in the Management of Metabolic-Associated Fatty Liver Disease (MAFLD) in Adults: A Position Statement from Exercise and Sport Science Australia
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“Behaviour change techniques that may support people with MAFLD include goal setting (e.g. via the Goal Attainment Scale [42]), self-monitoring of outcomes (e.g. waist circumference) and/or behaviours (e.g. via a pedometer, smartwatch-based application or other behaviour tracking application) and…”
Influential
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Method
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“…list of further recommendations for using GAS based on our experiences is provide in Appendix D, and it is suggested that this be used in combination with a checklist, such as that shown in Appendix C, and previously published guides to GAS (Bovend’Eerdt et al., 2009; Turner-Stokes, 2009a, b).”
BackgroundMethod
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“the Specific, Measurable, Attainable, Realistic Timed (SMART) concept [124].”
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“dimensions of changeand the end of treatment scenarios are meaningful [14,35,43,44,45].”
Background
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Method
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“A framework for the use of SMART goals in rehabilitation has been designed to accommodate the dynamic nature of this environment [25].”
Method
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BackgroundMethodResultInfluential
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Background
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Method
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“physical, cultural, social, economic and political) contribute to context-specific GAS levels (8).”
BackgroundMethodInfluential
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Method
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BackgroundMethod
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“Goals were set on basis of the “Specific Measurable Accepted Realistic Time Bound” (SMART) criteria [32].”
Background
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“Furthermore, patients are carefully instructed on how to formulate 2 or 3 individual SMART (specific, measurable, attainable, realistic and timely) treatment goals.(43,44) The second session is an individual session to help patients in wording their goals realistically and attainably, and to manage treatment expectati…”
Background
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“To further monitor treatment fidelity and help offset biases associated with using a diary to measure the achievement of a goal, we used goal attainment scaling (GAS) following the recommendations of Turner-Stokes et al [42,43].”
BackgroundMethod
A motor learning therapeutic intervention for a child with cerebral palsy through a social assistive robot
Buitrago, J. A., Roldán, A. M. B., & Caicedo, E. F. (2019) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2019.1578999 · Cited by 51
“GAS is a scale that allows setting individual objectives and is sensitive to minimum changes, which are clinically significant and difficult to appreciate using standardized scales, as Gross Motor Function Measure (GMFM), Timed Up and Go or 10 Metre Walk Test.”
MethodInfluential
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“Some researchers have suggested adding an extra − 3 score so that deterioration from the current level of functioning can be scored as well [37, 38].”
Background
How Effective is Health Coaching in Reducing Health Services Expenditures?
Jonk, Y. C., Lawson, K. L., O’Connor, H., Sundgaard-Riise, K., Eisenberg, D. M., Dowd, B. E., & Kreitzer, M. J. (2015) · Medical Care · doi:10.1097/mlr.0000000000000287 · Cited by 49
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van Dongen, J. J. J., van Bokhoven, M. A., Daniëls, R., van der Weijden, T., Emonts, W. W. G. P., & Beurskens, A. J. H. M. (2016) · BMC Family Practice · doi:10.1186/s12875-016-0535-7 · Cited by 49
“Goals can be explored and described as specific, measurable, assignable, realistic and timerelated (SMART) [37, 40, 41].”
Background
“What do you expect from physiotherapy?”: a detailed analysis of goal setting in physiotherapy
Schoeb, V., Staffoni, L., Parry, R. H., & Pilnick, A. (2013) · Disability and Rehabilitation · doi:10.3109/09638288.2013.867369 · Cited by 48
“One approach regularly advocated is the SMART (Specific, Measurable, Achievable, Realistic and Timed) approach to formulating goals [5].”
Background
Patient-led Goal Setting
Gardner, T., Refshauge, K. M., McAuley, J. H., Goodall, S., Hübscher, M., & Smith, L. D. (2016) · Spine · doi:10.1097/brs.0000000000001545 · Cited by 50
“At the initial session, participants were given a ‘‘Participant Handbook’’ comprising background information on the chronic pain model,(20) tips for self-management of CLBP, information on setting goals, and guidelines following the SMART model.(21) The therapist took an initial history of the participant’s back pain…”
Method
Do Old Errors Always Lead to New Truths? A Randomized Controlled Trial of Errorless Goal Management Training in Brain-Injured Patients
Bertens, D., Kessels, R. P. C., Fiorenzato, E., Boelen, D. H. E., & Fasotti, L. (2015) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617715000764 · Cited by 54
A multi-site study of the feasibility and clinical utility of Goal Attainment Scaling in geriatric day hospitals
Stolee, P., Awad, M., Byrne, K. M., DeForge, R. T., Clements, S., Glenny, C., & The Day Hospital Goal Attainment Scaling Interest Group of the Regional Geriatric Programs of Ontario (2012) · Disability and Rehabilitation · doi:10.3109/09638288.2012.660600 · Cited by 46
“Others have also suggested using a more structured process or a “standardized menu” to develop the list of goals for each client [39,76,77].”
Method
Self-regulation workshop and Occupational Performance Coaching with teachers: A pilot study
Hui, C. E., Snider, L., & Couture, M. M. (2016) · Canadian Journal of Occupational Therapy · doi:10.1177/0008417415627665 · Cited by 60
The iCanCope pain self-management application for adolescents with juvenile idiopathic arthritis: a pilot randomized controlled trial
Lalloo, C., Harris, L., Hundert, A. S., Berard, R. A., Cafazzo, J. A., Connelly, M. A., Feldman, B. M., Houghton, K. M., Huber, A. M., Laxer, R. M., et al. (2020) · Lara D. Veeken · doi:10.1093/rheumatology/keaa178 · Cited by 46
2017 National Standards for Diabetes Self-Management Education and Support
Beck, J. K., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., Cypress, M., Faulkner, P., Fischl, A. H., Francis, T., et al. (2019) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721719897952 · Cited by 54
Use of the PREPARE (PREhabilitation, Physical Activity and exeRcisE) program to improve outcomes after lumbar fusion surgery for severe low back pain: a study protocol of a person-centred randomised controlled trial
Lotzke, H., Jakobsson, M., Brisby, H., Gutke, A., Hägg, O., Smeets, R., den Hollander, M., Olsson, L., & Lundberg, M. (2016) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-016-1203-8 · Cited by 45
“This short-term goal should be specific, measurable, achievable, realistic and time-targeted (SMART-goal) [41] and should involve a physical activity that is important to the patient.”
Background
Goal Attainment Scaling Rehabilitation Improves Satisfaction with Work Activities for Younger Working Patients After Knee Arthroplasty
Hoorntje, A., Witjes, S., Koenraadt, K. L. M., Kuijer, P., Blankevoort, L., Kerkhoffs, G. M. M. J., & van Geenen, R. C. I. (2020) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.19.01471 · Cited by 45
“3 months 61 (18) 17 (21) 57 (19) 16 (21) 0.”
Rehabilitation Evidence-Based Decision-Making: The READ Model
Novak, I., Velde, A. T., Hines, A., Stanton, E., McNamara, M., Paton, M. C. B., Finch‐Edmondson, M., & Morgan, C. (2021) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2021.726410 · Cited by 51
How active are patients in setting goals during rehabilitation after stroke? A qualitative study of clinician perceptions
Parsons, J. G. M., Plant, S., Slark, J., & Tyson, S. F. (2016) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1253115 · Cited by 43
“Second, a conflict was apparent between patient-centered goal setting and the expectation that goals should comply with the “SMART” format (commonly interpreted as Specific, Measurable, Attainable, Relevant and Timely).[36,37] SMART goals were seen as a potential barrier to enabling patients to be actively involved in…”
Background
Optimising leisure participation: a pilot intervention study for adolescents with physical impairments
Imms, C., Mathews, S., Nicola‐Richmond, K., Law, M., & Ullenhag, A. (2015) · Disability and Rehabilitation · doi:10.3109/09638288.2015.1068876 · Cited by 45
“The prioritised leisure goals identified through the COPM were then transformed to SMART intervention goals [31] using the Goal Attainment Scale (GAS) [32].”
Method
Recognizing the need for personalization of haemophilia patient‐reported outcomes in the prophylaxis era
Recht, M., Konkle, B. A., Jackson, S. C., Neufeld, E. J., Rockwood, K. J., & Pipe, S. W. (2016) · Haemophilia · doi:10.1111/hae.13066 · Cited by 41
Patients’ views on their decision making during inpatient rehabilitation after newly acquired spinal cord injury—A qualitative interview‐based study
Scheel‐Sailer, A., Post, M. W. M., Michel, F., Weidmann‐Hügle, T., & Baumann‐Hölzle, R. (2017) · Health Expectations · doi:10.1111/hex.12559 · Cited by 41
Goal setting practice in chronic low back pain. What is current practice and is it affected by beliefs and attitudes?
Gardner, T., Refshauge, K. M., McAuley, J. H., Hübscher, M., Goodall, S., & Smith, L. D. (2018) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2018.1425785 · Cited by 40
2017 National Standards for Diabetes Self-Management Education and Support
Beck, J. K., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., Cypress, M., Faulkner, P., Fischl, A. H., Francis, T., et al. (2018) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721718820941 · Cited by 43
A randomized controlled trial on errorless learning in goal management training: study rationale and protocol
Bertens, D., Fasotti, L., Boelen, D. H. E., & Kessels, R. P. C. (2013) · BMC Neurology · doi:10.1186/1471-2377-13-64 · Cited by 41
“Acceptable treatment goals are those which can be subdivided into multiple steps and should be defined in accordance with the SMART method (Specific, Measurable, Attainable, Reasonable, Timely) [45].”
Method
Parent, child, and family outcomes following Acceptance And Commitment Therapy for parents of autistic children: A randomized controlled trial
Maughan, A. L., Lunsky, Y., Lake, J., Mills, J. S., Fung, K., Steel, L., & Weiss, J. A. (2024) · Autism · doi:10.1177/13623613231172241 · Cited by 37
Management of Persistent Cognitive Symptoms After Sport-Related Concussion
Sohlberg, M. M., & Ledbetter, A. K. (2016) · American Journal of Speech-Language Pathology · doi:10.1044/2015_ajslp-14-0128 · Cited by 37
Goal setting improves retention in youth mental health: a cross-sectional analysis
Cairns, A., Kavanagh, D. J., Dark, F. L., & McPhail, S. (2019) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-019-0288-x · Cited by 37
Does Activity-Based Rehabilitation With Goal Attainment Scaling Increase Physical Activity Among Younger Knee Arthroplasty Patients? Results From the Randomized Controlled ACTION Trial
Hoorntje, A., Witjes, S., Kuijer, P., Bussmann, J. B. J., Horemans, H. L. D., Kerkhoffs, G. M. M. J., van Geenen, R. C. I., & Koenraadt, K. L. M. (2019) · The Journal of Arthroplasty · doi:10.1016/j.arth.2019.10.028 · Cited by 37
Intensive virtual reality-based training for upper limb motor function in chronic stroke: a feasibility study using a single case experimental design and fMRI
Schuster‐Amft, C., Henneke, A., von Hartog-Keisker, B. V., Holper, L., Siekierka, E., Chevrier, E., Pyk, P., Kollias, S., Kiper, D., & Eng, K. (2014) · Disability and Rehabilitation Assistive Technology · doi:10.3109/17483107.2014.908963 · Cited by 38
“The Goal Attainment Scale (GAS) was used to set a specific activity of daily life as an achievable goal for the intervention period [24,25].”
Method
2017 National Standards for Diabetes Self-Management Education and Support
Beck, J. K., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., Cypress, M., Faulkner, P., Fischl, A. H., Francis, T., et al. (2021) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721720987926 · Cited by 39
Agreement between Two Different Scoring Procedures for Goal Attainment Scaling is Low
Bovend’Eerdt, T. J. H., Dawes, H., Izadi, H., & Wade, D. T. (2011) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-0624 · Cited by 35
Self-citation
Goal Setting and Achievement in Individualized Rehabilitation of Younger Total and Unicondylar Knee Arthroplasty Patients: A Cohort Study
Witjes, S., Hoorntje, A., Kuijer, P., Koenraadt, K. L. M., Blankevoort, L., Kerkhoffs, G. M. M. J., & van Geenen, R. C. I. (2018) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2018.11.019 · Cited by 36
Transitional rehabilitation goals for people with spinal cord injury: looking beyond the hospital walls
Wallace, M. A., & Kendall, M. B. (2013) · Disability and Rehabilitation · doi:10.3109/09638288.2013.805259 · Cited by 35
“[26] suggested that most goals are typically written around activity and participation”
Background
Supporting Goal-Oriented Primary Health Care for Seniors with Complex Care Needs Using Mobile Technology: Evaluation and Implementation of the Health System Performance Research Network, Bridgepoint Electronic Patient Reported Outcome Tool
Gray, C. S., Wodchis, W. P., Upshur, R. E. G., Cott, C. A., McKinstry, B., Mercer, S. W., Palen, T. E., Ramsay, T., & Thavorn, K. (2016) · JMIR Research Protocols · doi:10.2196/resprot.5756 · Cited by 35
“The second is a modified standard goal attainment scale [33] to assess goal progress depicted in Table 1.”
ICF-inspired goal-setting in developmental rehabilitation: an innovative framework for pediatric therapists
Angeli, J. M., Schwab, S. M., Huijs, L., Sheehan, A., & Harpster, K. L. (2019) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2019.1692392 · Cited by 34
A synthesis and appraisal of clinical practice guidelines, consensus statements and Cochrane systematic reviews for the management of focal spasticity in adults and children
Williams, G. P., Singer, B., Ashford, S. A., Hoare, B., Hastings‐Ison, T., Fheodoroff, K., Berwick, S., Sutherland, E., & Hill, B. E. (2020) · Disability and Rehabilitation · doi:10.1080/09638288.2020.1769207 · Cited by 34
“…or walking, or causing pain, treatment should be integrated, goal-directed and include outcomes which are evaluated using specific, measurable, achievable, relevant and timed (SMART) goals [38] and International classification of functioning, disability and health (ICF) [39–41] frameworks.”
A tele-health intervention to increase physical fitness in people with spinal cord injury and cardiometabolic disease or risk factors: a pilot randomized controlled trial
Bombardier, C. H., Dyer, J. R., Burns, P. A., Crane, D. A., Takahashi, M. M., Barber, J. K., & Nash, M. S. (2020) · Spinal Cord · doi:10.1038/s41393-020-0523-6 · Cited by 39
A large-scale experiment on New Year’s resolutions: Approach-oriented goals are more successful than avoidance-oriented goals
Oscarsson, M., Carlbring, P., Andersson, G., & Rozental, A. (2020) · PLoS ONE · doi:10.1371/journal.pone.0234097 · Cited by 34
iCanCope with pain: cultural adaptation and usability testing of a self-management app for adolescents with persistent pain in Norway
Grasaas, E., Fegran, L., Helseth, S., Stinson, J., Martinez, S., Lalloo, C., & Haraldstad, K. (2019) · JMIR Research Protocols · doi:10.2196/12940 · Cited by 35
“The development of the app’s goals feature was consistent with the SMART framework—specific, measurable, achievable, realistic, and timed [28,29].”
Method
A cognitive behaviour therapy (CBT) programme for anxiety following moderate–severe traumatic brain injury (TBI): Two case studies
Hsieh, M.-Y., Ponsford, J. L., Wong, D. K., Schönberger, M., McKay, A., & Haines, K. (2012) · Brain Injury · doi:10.3109/02699052.2011.635365 · Cited by 33
“To accommodate executive dysfunction affecting planning, idea generation and abstract reasoning, clients were guided to choose specific, measurable and realistic goals that would help to provide most symptom reduction [36].”
Background
Lifestyle Medicine in Medical Education: Maximizing Impact
Frates, B., Ortega, H., Freeman, K. J., Co, J. P. T., & Bernstein, M. (2024) · Mayo Clinic Proceedings Innovations Quality & Outcomes · doi:10.1016/j.mayocpiqo.2024.07.003 · Cited by 36
Intrathecal baclofen treatment in dystonic cerebral palsy: a randomized clinical trial: the IDYS trial
Bonouvrié, L. A., Becher, J. G., Vles, J. S. H., Boeschoten, K., Soudant, D. L. H. M., de Groot, V., van Ouwerkerk, W. J. R., STRIJERS, R. L. M., Foncke, E. M. J., Geytenbeek, J., et al. (2013) · BMC Pediatrics · doi:10.1186/1471-2431-13-175 · Cited by 31
“The target activity, specific support and time period should be specified and performance should be quantified using distance, frequency or time taken to accomplish a task [14].”
BackgroundMethodInfluential
Effects of goal clarification on impulsivity and academic procrastination of college students
Muñoz-Olano, J. F., & Hurtado‐Parrado, C. (2017) · Revista Latinoamericana de Psicología · doi:10.1016/j.rlp.2017.03.001 · Cited by 41
What do Kids with Acquired Brain Injury Want? Mapping Neuropsychological Rehabilitation Goals to the International Classification of Functioning, Disability and Health
McCarron, R. H., Watson, S., & Gracey, F. (2019) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617719000213 · Cited by 32
Recent Advances in Cognitive Behavioral Therapy For Digestive Disorders and the Role of Applied Positive Psychology Across the Spectrum of GI Care
Feingold, J. H., Murray, H. B., & Keefer, L. (2019) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001234 · Cited by 33

Authors: Bovend'Eerdt, T. J., Botell, R. E., & Wade, D. T.
Affiliations: Oxford Brookes University and Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford,
Nuffield Orthopaedic Centre (GB)
ORCID: Wade, Derick T
Venue: Clinical Rehabilitation
Publisher: SAGE Publications
Published: 2009-02-23
Volume: 23
Issue: 4
Pages: 352-361
ISSN: 0269-2155 (ISSN-L)
1477-0873
DOI: 10.1177/0269215508101741
OpenAlex: W2131171698
Cited by: 754
References: 19
Citations by year: 2026: 54 · 2025: 64 · 2024: 76 · 2023: 66 · 2022: 66 · 2021: 73 · 2020: 60 · 2019: 57 · 2018: 43 · 2017: 36 · 2016: 45 · 2015: 25 · 2014: 30 · 2013: 25 · 2012: 12
FWCI: 28.78
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Clinical Rehabilitation (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Health Sciences › Health Professions › Occupational Therapy › Occupational Therapy Practice and Research
Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Keywords: SMART goals, goal setting, goal attainment scaling, rehabilitation goals, goal formulation, patient-centered goals, interdisciplinary rehabilitation
MeSH terms: Goals, Humans, Occupational Therapy, Patient Care Planning

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Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide

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