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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“It is also based on SMART goal setting [64, 65].”
Method
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Background
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“Goal statements are specified according to SMART principles; they are specific, measurable, achievable, realistic, and timed [34].”
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Background
A multicentre cluster-randomized controlled study to evaluate a train-the-trainer programme for implementing internal and external participation in medical rehabilitation
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“Participant feedback on this negotiation phase emphasized the importance of SMART principles in the identification and specification of goals (Bovend’Eerdt et al., 2009).”
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“[40,41] and that they were specific and measurable.”
Background
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“goal writing skills to create specific and meaningful goals [28,30,31].”
Background
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Background
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“Goal setting will follow the SMART goal approach (Specific, Measureable, Attainable, Realistic, and Time specific) [51,52].”
Method
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Method
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“, formulated according to the concepts embodied in the SMART acronym [10], although different interpretations of the acronym exist [4,11].”
Method
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“As part of the pre-study preparation, they were lectured about the sMArT criterion for goal definition [23] which is an acronym for specific, Measurable, Achievable, relevant, and Timed [23,24].”
Method
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“Although patients’ broad goals were pertinent, they did not have the characteristics of goals that lead to motivation and planning (Locke & Latham, 2002; Lorig & Holman, 2003; Bovend’Eerdt et al., 2009).”
Background
Specific, personally meaningful cues can benefit episodic prospection in medial temporal lobe amnesia
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“specific, measurable, attainable, realistic, time oriented) [38].”
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“2 Flowchart of the CICI study goals are Specific, Measurable, Achievable, Realistic/ Relevant, and Timed [63].”
Background
A multicenter explanatory survey of patients’ and clinicians’ perceptions of motivational factors in rehabilitation
Oyake, K., Yamauchi, K., Inoue, S., Sue, K., Ota, H., Ikuta, J., Ema, T., Ochiai, T., Hasui, M., Hirata, Y., et al. (2023) · Communications Medicine · doi:10.1038/s43856-023-00308-7 · Cited by 24
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“…goal-setting exercise integrating implementation intentions to strengthen goal attainment (Brandstätter et al., 2001; Gollwitzer & Sheeran, 2006) which is evidenced as being effective in SUD (Bovend-Eerdt et al., 2009; Lozano & Stephens, 2010; National Treatment Agency for Substance Misuse, 2006).”
BackgroundInfluential
Use of accelerometer-based activity monitoring in orthopaedics: benefits, impact and practical considerations
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“These were discussed with gait laboratory staff to establish SMART goals [9].”
Method
Timing and correction of stepping movements with a virtual reality avatar
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“In the rehabilitation of lower limb function, patients are set goal-oriented functional tasks, such as walking, turning and stepping over objects[36], depending on the nature of their impairment.”
Background
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Integrative Medicine Strategies for Changing Health Behaviors
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“By the end of the program, all patients will have made a specified plan addressing how to integrate the change into normal living using the concept of SMART (specific, measurable, achievable, relevant, time-bound) goals [35,36].”
Goal setting for nutrition and body weight in rehabilitation nutrition: position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication)
Wakabayashi, H., Yoshimura, Y., Maeda, K., Fujiwara, D., Nishioka, S., & Nagano, A. (2021) · Journal of General and Family Medicine · doi:10.1002/jgf2.509 · Cited by 22
A randomized controlled study of whether setting specific goals improves the effectiveness of therapy in people with Parkinson’s disease
Martos, I. C., Ortíz‐Rubio, A., Torres‐Sánchez, I., Rodríguez‐Torres, J., López‐López, L., & Valenza, M. C. (2018) · Clinical Rehabilitation · doi:10.1177/0269215518815217 · Cited by 22
Effectiveness of a primary care based complex intervention to promote self-management in patients presenting psychiatric symptoms: study protocol of a cluster-randomized controlled trial
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“In cooperation with the patient, the APN explores the motivation for change, gathering goals for the patients using the SMART-criteria [23]: Specific, Measurable, Achievable, Realistic/Relevant, Timed.”
Method
The effect on subjective quality of life of occupational therapy based on adjusting the challenge–skill balance: a randomized controlled trial
Yoshida, I., Hirao, K., & Kobayashi, R. (2019) · Clinical Rehabilitation · doi:10.1177/0269215519858713 · Cited by 22
CanDirect: Effectiveness of a Telephone-Supported Depression Self-Care Intervention for Cancer Survivors
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Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice
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Sarcopenic Dysphagia and Simplified Rehabilitation Nutrition Care Process: An Update
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“Goal setting in rehabilitation nutrition is based on SMART, an effective goal setting method to improve goal attainment [87].”
Method
Integrated, Team-Based Chronic Pain Management: Bridges from Theory and Research to High Quality Patient Care
Driscoll, M., & Kerns, R. D. (2016) · Advances in experimental medicine and biology · doi:10.1007/978-94-017-7537-3_10 · Cited by 21
Differential effects of cognition-focused interventions for people with Alzheimer’s disease: A meta-analysis.
Oltra‐Cucarella, J., Ferrer‐Cascales, R., Clare, L., Morris, S. B., Espert, R., Ustárroz, J. T., & Sánchez‐SanSegundo, M. (2018) · Neuropsychology · doi:10.1037/neu0000449 · Cited by 24
Setting and achieving individualized social communication goals for people with acquired brain injury (ABI) within a group treatment
Behn, N., Marshall, J., Togher, L., & Cruice, M. N. (2019) · International Journal of Language & Communication Disorders · doi:10.1111/1460-6984.12488 · Cited by 24
Evaluation of a Newly Developed Smartphone App for Risk Factor Management in Young Patients With Ischemic Stroke: A Pilot Study
Fruhwirth, V., Berger, L. M., Gattringer, T., Fandler‐Höfler, S., Kneihsl, M., Schwerdtfeger, A. R., Weiss, E. M., Enzinger, C., & Pinter, D. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2021.791545 · Cited by 21
A randomized, single-blind cross-over design evaluating the effectiveness of an individually defined, targeted physical therapy approach in treatment of children with cerebral palsy
Franki, I., den Broeck, C. V., Cat, J. D., Tijhuis, W., Molenaers, G., Vanderstraeten, G., & Desloovere, K. (2014) · Clinical Rehabilitation · doi:10.1177/0269215514544984 · Cited by 21
Usefulness of Goal Attainment Scaling in Intensive Stroke Rehabilitation During the Subacute Stage
Jung, Y., Sim, J., Park, J., Kim, J., & Kim, M. (2020) · Annals of Rehabilitation Medicine · doi:10.5535/arm.19087 · Cited by 20
“Furthermore, it is pointed out that the discontinuity (-2, -1, 0, +1, and +2) that assesses whether an expected outcome is achieved or not is not appropriate in assessing partial goal attainment [31].”
Background
Understanding the Technological Practices and Needs of Music Therapists
Baglione, A. N., Clemens, M. P., Maestre, J. F., Min, A., Dahl, L., & Shih, P. C. (2021) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3449107 · Cited by 22
“In rehabilatory or therapeutic settings (such as music therapy), these goals are used to measure the efficacy of the therapist’s chosen intervention for the client [11].”
Background
Patient Motivations and Goals for Bariatric Surgery: A Mixed Methods Study
Ahlich, E. M., Verzijl, C. L., Cunning, A., Wright, E., & Rancourt, D. (2021) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2021.05.017 · Cited by 20
Feasibility and Acceptability of a Complex Telerehabilitation Intervention for Pediatric Acquired Brain Injury: The Child in Context Intervention (CICI)
Holthe, I. L., Rohrer-Baumgartner, N., Svendsen, E. J., Hauger, S. L., Forslund, M. V., Borgen, I. M. H., Øra, H. P., Kleffelgård, I., Strand-Saugnes, A. P., Egeland, J., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11092564 · Cited by 20
“SMART-goals (Specific, Measurable, Achievable, Realistic/Relevant and Timed) [54] were established in collaboration between the family and the therapist in videoconference family sessions.”
Background
Standardised approach to measuring goal-based outcomes among older disabled adults: results from a multisite pilot
Giovannetti, E. R., Clair, C. A., Jennings, L. A., Sandberg, S. F., Bowman, A. M., Reuben, D. B., & Scholle, S. H. (2020) · BMJ Quality & Safety · doi:10.1136/bmjqs-2019-010742 · Cited by 20
Developing person-centred goal setting resources with and for people with aphasia: a multi-phase qualitative study
Elston, A., Barnden, R., Hersh, D., Godecke, E., Cadilhac, D. A.-M., Lannin, N. A., Kneebone, I., & Andrew, N. E. (2021) · Aphasiology · doi:10.1080/02687038.2021.1907294 · Cited by 20
“Person-centred goal setting is recognised as an effective method of improving patient outcomes and is recommended in international clinical guidelines (Bovend’Eerdt et al., 2009; Heart and Stroke Foundation, 2019; Royal College of Physicians, 2016; Stroke Foundation, 2019).”
Method
Rehabilitation goals of people with spinal cord injuries can be classified against the International Classification of Functioning, Disability and Health Core Set for spinal cord injuries
Haas, B. M., Playford, E. D., Ahmad, A., Yildiran, T., Gibbon, A. J., & Freeman, J. A. (2015) · Spinal Cord · doi:10.1038/sc.2015.155 · Cited by 20
Healthcare Quality Indicators for Physiotherapy Management in Hip and Knee Osteoarthritis and Rheumatoid Arthritis: A Delphi Study
Peter, W. F., Hurkmans, E. J., van der Wees, P. J., Hendriks, E., van Bodegom‐Vos, L., & Vlieland, T. P. M. V. (2016) · Musculoskeletal Care · doi:10.1002/msc.1133 · Cited by 20
Using the Behavior Change Technique Taxonomy v1 to conceptualize the clinical content of Breaking Free Online: a computer-assisted therapy program for substance use disorders
Dugdale, S., Ward, J., Hernen, J., Elison, S., Davies, G., & Donkor, D. (2016) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-016-0069-y · Cited by 20
“Evidence suggests that effective goals should be specific, measurable, achievable, realistic and time-bound [105].”
Background
How to help students in their transition to middle school? Effectiveness of a school-based group mentoring program promoting students’ engagement, self-regulation, and goal setting
Martins, J., Rosário, P., Cunha, J., Carlos Núñez, J., Vallejo, G., & Moreira, T. (2024) · Contemporary Educational Psychology · doi:10.1016/j.cedpsych.2023.102230 · Cited by 24
Impact of an Online Sleep and Circadian Education Program on University Students’ Sleep Knowledge, Attitudes, and Behaviours
Semsarian, C. R., Rigney, G., Cistulli, P. A., & Bin, Y. S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910180 · Cited by 23
Feasibility of virtual Alzheimer's biomarker disclosure: Findings from an observational cohort
Erickson, C. M., Chin, N. A., Rosario, H. L., Peterson, A., Johnson, S. C., & Clark, L. R. (2023) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1002/trc2.12413 · Cited by 19
Effectiveness of an eHealth‐Delivered Program to Empower People With Musculoskeletal Pain in Rural Australia: A Randomized Controlled Trial
Castrillón, C. I. M., Simić, M., Ferreira, M. L., Bennell, K. L., Luscombe, G. M., Gater, K., Beckenkamp, P. R., Michell, A., Bauman, A. E., de Luca, K. E., et al. (2023) · Arthritis Care & Research · doi:10.1002/acr.25272 · Cited by 25
“The exercise program was designed individually and tailored according to participants ’ preferences, participants ’ individual goals (speci ﬁ c, measurable, achievable, realistic or relevant, and timed), 23 and participants ’ abilities to perform exercises remotely.”
Method
Secondary prevention of UV-induced skin cancer: development and pilot testing of an educational patient counseling approach for individual sun protection as standard procedure of patient care
Ludewig, M., Rocholl, M., John, S. M., & Wilke, A. (2020) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-020-01532-7 · Cited by 19
Improving Metabolic and Cardiovascular Health at an Early Psychosis Intervention Program in Vancouver, Canada
Fredrikson, D. H., Boyda, H. N., Tse, L., Whitney, Z., Pattison, M. A., Ott, F. J., Hansen, L., & Barr, A. M. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2014.00105 · Cited by 19
“, goals must be Specific, Measurable, Achievable, Realistic, and T ime related) (34).”
Background
Real-World Goal Setting and Use of Outcome Measures According to the International Classification of Functioning, Disability and Health: A European Survey of Physical Therapy Practice in Multiple Sclerosis
Řasová, K., Martinková, P., Soler, B., Freeman, J. A., Cattaneo, D., Jonsdottir, J., Smedal, T., Romberg, A., Henze, T., Santoyo-Medina, C., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17134774 · Cited by 19
“They were also asked about the number of goals they set, and their utilization of the SMART (Specific, Measurable, Achievable, Realistic, Timed) approach [20] to setting and monitoring goals.”
Background
Processes in Rehabilitation
Levack, W., & Dean, S. G. (2012) · doi:10.1002/9781118702741.ch4 · Cited by 19
Evaluating Engagement in a Digital and Dietetic Intervention Promoting Healthy Weight Gain in Pregnancy: Mixed Methods Study
Willcox, J. C., Chai, D., Beilin, L. J., Prescott, S. L., Silva, D. T., Neppe, C., & Huang, R. (2020) · Journal of Medical Internet Research · doi:10.2196/17845 · Cited by 18
“Women were asked to set a specific, measurable, attainable, realistic, and time-based (SMART) goal [28] to assist them with lifestyle behavior change.”
Background
The Importance of Motivation to Older Adult Physical and Cognitive Exercise Program Development, Initiation, and Adherence
O’Neil-Pirozzi, T. M., Cattaneo, G., Sánchez, J. S., Gomes‐Osman, J., & Pascual‐Leone, Á. (2022) · Frontiers in Aging · doi:10.3389/fragi.2022.773944 · Cited by 20
“For example, one strategy to maximize initiation of exercise programs is the setting of specific, personalized, and realizable goals (Bovend’Eerdt et al., 2009; O’Neil-Pirozzi, 2021b; O’NeilPirozzi et al., 2019; Rivera-Torres et al., 2019; Ryan et al., 2009).”
Background
Structured exercise programs for higher education students experiencing mental health challenges: background, significance, and implementation
Jeftic, I., Furzer, B. J., Dimmock, J. A., Wright, K. E., Boyd, C., Budden, T., Rosenberg, M., Kramer, B., Buist, B. D., Fitzpatrick, I., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1104918 · Cited by 31
“Traditionally, exercise goal setting recommendations have been focused on formulating specific and measurable actions (71).”
Background
Identifying Behavior Change Techniques in an Artificial Intelligence-Based Fitness App: A Content Analysis
Kuru, H. (2023) · Health Education & Behavior · doi:10.1177/10901981231213586 · Cited by 21
“Employing a simple strategy would assist users in developing specific, measurable, achievable, relevant, and time-bound objectives (SMART) (Bovend’Eerdt et al., 2009).”
Method
Upper limb strength training in subacute stroke patients: study protocol of a randomised controlled trial
Högg, S., Holzgraefe, M., Wingendorf, I., Mehrholz, J., Herrmann, C., & Obermann, M. (2019) · Trials · doi:10.1186/s13063-019-3261-3 · Cited by 20
Effects of a remotely supervised motor rehabilitation program for individuals with Rett syndrome at home
Romano, A., Rosa, G. D., Tisano, A., Fabio, R. A., & Lotan, M. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1949398 · Cited by 18
Appropriateness, Acceptability, and Feasibility of a Neurodiversity-Based Self-determination Program for Autistic Adults
McDonald, T. A. M., Lalani, S., Chen, I., Cotton, C. M., MacDonald, L. L., Boursoulian, L. J., Wang, J., & Malow, B. A. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05598-9 · Cited by 18
“Goal attainment scaling (Bovend’Eerdt et al., 2009) The Goal Attainment Scaling identifies five levels of goal attainment (0–4) ranging from no progress to progress that was much greater than anticipated.”
Background
Creating Individualized Symptom Management Goals and Strategies for Cancer-Related Fatigue for Patients With Recurrent Ovarian Cancer
Hagan, T. L., Arida, J. A., Hughes, S. H., & Donovan, H. S. (2016) · Cancer Nursing · doi:10.1097/ncc.0000000000000407 · Cited by 18
“The SMART acronym has been discussed in a number of professional literatures including rehabilitation, occupational therapy, and psychology and has been found to be associated with better goal attainment.(31,32) In short, patients are more likely to achieve their health-related goals if they know (S) specifically what…”
Background
Combined Effects of Early Mobilization and Nutrition on ICU-Acquired Weakness
Formenti, P., Menozzi, A., Sabbatini, G., Gotti, M., Galimberti, A., Bruno, G., Pezzi, A., & Umbrello, M. (2025) · Nutrients · doi:10.3390/nu17061073 · Cited by 22
Effects of assistive technology-based occupational therapy on community-dwelling people recovering from stroke
Lim, Y., Kim, S.-Y., Yoo, D., & Kim, H. (2020) · Assistive Technology · doi:10.1080/10400435.2020.1789900 · Cited by 17
Effects of a self‐management training for people with intellectual disabilities
Sandjojo, J., Zedlitz, A. M. E. E., Gebhardt, W. A., Hoekman, J., den Haan, J. A., & Evers, A. W. M. (2018) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.12536 · Cited by 22
Structured Water Dance Intervention (SWAN) for adults with profound intellectual and multiple disabilities: study protocol
Lundqvist, L., Matérne, M., Granberg, A., Frank, A., Arvidsson, P., & Duberg, A. (2020) · Heliyon · doi:10.1016/j.heliyon.2020.e04242 · Cited by 17
“The degree of fulfilment of the targeted goal is scored on a five-point scale from -2 (‘muchworse than expected’) toþ2 (‘much better than expected’), where 0 is the expected target [29].”
Background
The Role of Music Therapy for Children Undergoing Cancer Treatment in Singapore
Wong, K. C., Tan, B. W. Z., Tong, J. W. K., & Chan, M. Y. (2021) · Healthcare · doi:10.3390/healthcare9121761 · Cited by 17
“The process of rating the GAS in MT was similar to those reported in Bovend’Eerdt, Botell and Wade [20], and Carpente [19].”
Result
Physiotherapists' experience of client participation in physiotherapy interventions: A phenomenographic study
Larsson, I., Liljedahl, K., & Gard, G. E. (2010) · Advances in Physiotherapy · doi:10.3109/14038196.2010.497543 · Cited by 17
“Focusing on ICF components of activity and participation, as this often is of most concern for clients and their relatives, will make therapy more effective and meaningful for both the client and the physiotherapist (6,28).”
BackgroundInfluential
Patient participation in action: patients’ interactional initiatives during interdisciplinary goal-setting meetings in a rehabilitation clinic
Keel, S., & Schoeb, V. (2017) · Text and Talk · doi:10.1515/text-2017-0004 · Cited by 17
“According to the clinic’s guidelines, the goals need to be formulated in accordance with the SMART guidelines (Specific, Measurable, Achievable, Relevant and Timely Goals; Bovend’Eerdt et al. 2009) in general, and the patient’s overall goal in particular (see Section 2).”
Method
Patient- and caregiver-identified preferences: Dimensions of change in developmental therapy treatment goals
Angeli, J. M., Harpster, K. L., Hanson, E., Sheehan, A., & Schwab, S. M. (2018) · Developmental Neurorehabilitation · doi:10.1080/17518423.2018.1425754 · Cited by 17
Mobile health delivered physical activity after mild stroke or transient ischemic attack: Is it feasible and acceptable?
Thurston, C., Humphries, S., Bezuidenhout, L., Johansson, S., Holmlund, L., von Koch, L., English, C., & Conradsson, D. M. (2025) · International Journal of Stroke · doi:10.1177/17474930251315628 · Cited by 15
Feasibility of a home-based program to improve handwriting after stroke: a pilot study
Simpson, B., McCluskey, A., Lannin, N. A., & Cordier, R. (2015) · Disability and Rehabilitation · doi:10.3109/09638288.2015.1059495 · Cited by 16
Goal attainment scaling for patients with low back pain in rehabilitation: A systematic review
Haladay, D. E., Swisher, L. L., & Hardwick, D. (2021) · Health Science Reports · doi:10.1002/hsr2.378 · Cited by 16

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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