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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“91 Goal setting led to intervention planning and delivery, which directly addressed the adolescent's priorities.”
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Burnes, D. P. R., & Lachs, M. S. (2015) · Journal of Applied Gerontology · doi:10.1177/0733464815581486 · Cited by 16
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BackgroundMethod
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Hanssen, K. T., Benth, J. Š., Beiske, A. G., Landrø, N. I., & Hessen, E. (2014) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2014.971818 · Cited by 16
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BackgroundMethod
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“During the individual value-based goal-setting session with the motivational coach, each participant set one value-based personalized goal that was specific, measurable, attainable, realistic, and time-orientated (SMART) [37].”
BackgroundMethod
A training programme for community pharmacists to support people living with severe and persistent mental illness: Intervention mapping in the context of a pandemic
McMillan, S. S., El‐Den, S., O’Reilly, C. L., Roennfeldt, H., Theodorus, T., Chapman, J., Bailey, K. A., Crump, K., Collins, J. C., Ng, R., et al. (2022) · Health Education Journal · doi:10.1177/00178969221130461 · Cited by 19
“, 2011; Prochaska and Velicer, 1997), goal-setting (Bovend’Eerdt et al., 2009) and motivational interviewing (Diclimente and Velasquez, 2002), as well as evidence-based literature pertaining to meeting the physical”
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Development of a Job Retention Vocational Rehabilitation Intervention for People with Multiple Sclerosis Following the Person-Based Approach
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“32,33 The content of the sessions should be selected to achieve the intervention goals.”
Background
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Lewis, V. J., Dell, L., & Matthews, L. R. (2013) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-1131 · Cited by 15
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“There are benefits to using the GAS, but this tool requires some level of training and experience to develop goals that are SMART (specific, measurable, achievable, realistic and timed) [32].”
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“, medications, behavioral health, physical modalities, and procedural/manual therapies; [7] provide participants a detailed list of current pain management options through VA and the community; [8] inventory participants' personal values and life goals; [9] discuss the importance of defining goals that are specific, m…”
Background
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“” Originally developed in the context of mental health,[23] it is increasingly taken up in clinical practice, and it has been applied in various areas of complex intervention including rehabilitation[24,25] and treatment for the ULS.”
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“At the end of the MBR, the patients, together with the health professionals, developed patientspecific, long-term goals by applying the SMART-technique (specific, measureable, achievable, relevant, time bound) [16].”
Method
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Background
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Lemieux, J., Kawchuk, G. N., Kongsted, A., Hartvigsen, J., Abdollah, V., & Jones, C. A. (2021) · Pilot and Feasibility Studies · doi:10.1186/s40814-020-00758-z · Cited by 13
“rehabilitation goal setting) [22] are discussed then established, and the starting level of 8 separate groups of exercises is determined [12].”
Background
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“To estimate the extent to which these personal expectations are met, expectations should be formulated according to structured criteria (for instance, SMART criteria) and graded according to a predetermined grading scale [38, 39].”
Background
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“The process of establishing SMART goals, GAS, and Action plans was based on recommendations for collaborative goal setting from several authors [50,59,60].”
Method
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“We reviewed the literature to identify additional behaviour change techniques, which included action planning (35), identification of barriers to exercise and use of problem solving strategies including SMART (Specific, Measurable, Achievable, Relevant and Timely) goal setting to motivate participants to continue with…”
Method
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“Based on the review of results and a shared decision making process [23–25], health and functioning problems are discussed among the patient and the interdisciplinary team to find an agreement on treatment goals [26,27].”
Background
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Method
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“For proximal goal setting, the SMART (speci ﬁ c, measurable, achievable, relevant, and time-bound) framework can be used (20).”
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Method
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“A goal should be Specific, Measurable, Achievable, Realistic/ relevant and Timed (SMART) [13].”
BackgroundMethodInfluential
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“2) These goals were converted to SMART goals (Specific, Measurable, Achievable, Relevant, and Time-Bound (Bovend’Eerdt et al., 2009)).”
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“Adequate formulation: The theory of the formulation of goals recommends adherence to the SMART recommendations (36,37).”
Method
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Valaas, H. L., Klokkerud, M., Hildeskår, J., Hagland, A. S., Kjønli, E., Mjøsund, K., Øie, L., Wigers, S. H., Eppeland, S. G., Høystad, T. Ø., et al. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.2003879 · Cited by 11
Feasibility of six-point Goal Attainment Scale among subacute and chronic stroke patients
Debreceni-Nagy, A., Horvath, J. E., Nagy, S., Bajusz-Leny, Á., & Jenei, Z. (2019) · International Journal of Rehabilitation Research · doi:10.1097/mrr.0000000000000372 · Cited by 11
“SMART (specific, measurable, achievable, realistic, timed) principle was applied during goal formulation, which helped us shepherd our patients to choose realistic goals (Bovend’Eerdt et al., 2009).”
Method
Goal-Setting Instruction: A Step-by-Step Guide for High School Students
Estrapala, S., & Reed, D. K. (2019) · Intervention in School and Clinic · doi:10.1177/1053451219881717 · Cited by 11
Individualized goal attainment scaling during a trial of positive behaviour support in adults with acquired brain injury
Gould, K. R., Feeney, T. J., Hicks, A. J., & Ponsford, J. L. (2021) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2021.1947325 · Cited by 11
Developing indicators and measures of high-quality for Australian general practice
Metusela, C., Cochrane, N., van Werven, H., Usherwood, T. P., Ferdousi, S., Messom, R., O’Halloran, D., Fasher, M., Page, A., Trankle, S. A., et al. (2022) · Australian Journal of Primary Health · doi:10.1071/py21164 · Cited by 11
Utilizing Technology for Diet and Exercise Change in Complex Chronic Conditions Across Diverse Environments (U-DECIDE): Protocol for a Randomized Controlled Trial
Brown, R. C. C., Jegatheesan, D. K., Conley, M. M., Mayr, H. L., Kelly, J. T., Webb, L., Barnett, A., Staudacher, H. M., Burton, N. W., Isbel, N. M., et al. (2022) · JMIR Research Protocols · doi:10.2196/37556 · Cited by 11
“Participants will be encouraged to set SMART (specific, measurable, achievable, realistic, timely) goals [43].”
Background
The Borg scale is a sustainable method for prescribing and monitoring self-administered aerobic endurance exercise in patients with chronic kidney disease
Svensson, P., Hellberg, M., Zhou, Y., Wisén, A. G. M., & Clyne, N. (2022) · European Journal of Physiotherapy · doi:10.1080/21679169.2022.2086293 · Cited by 11
“These characteristics are well recognised when writing SMART goals to attain behavioural change [25].”
Background
Diet and Exercise in the Management of Polycystic Ovary Syndrome: Practical Considerations for Person-Centered Care
Colombo, G. E., Pirotta, S., & Sabag, A. (2023) · Seminars in Reproductive Medicine · doi:10.1055/s-0043-1777116 · Cited by 23
“25 This approach will often involve using SMART goals (Speci ﬁ c, Measurable, Achievable, Relevant, and Time-Bound), 26 self-monitoring, problem-solving, and focusing on stimulus control, among other interventions.”
Method
Prática centrada no cliente na reabilitação: definição, instrumentos e desafios
Vaz, D. V., Jubilini, L. G., & Queiroz, L. C. (2017) · Revista de Terapia Ocupacional da Universidade de São Paulo · doi:10.11606/issn.2238-6149.v28i1p122-127 · Cited by 11
A tailored counseling and home-based rehabilitation program to increase physical activity and improve mobility among community-dwelling older people after hospitalization: protocol of a randomized controlled trial
Turunen, K. M., Aaltonen, L. A., Kumpumäki, J., Portegijs, E., Keikkala, S., Kinnunen, M.-L., Finni, T. J., Sipilä, S., & Nikander, R. (2017) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-017-1825-5 · Cited by 11
“Their own goals and wishes are discussed to enable them to set goals based on the SMART principle (specific, measurable, achievable, realistic and time-based) [41].”
Background
Goal statements in brain injury rehabilitation: A cohort study of client-centredness and relationship with goal outcome
Prescott, S., Doig, E., Fleming, J., & Weir, N. (2019) · Brain Impairment · doi:10.1017/brimp.2019.6 · Cited by 11
Values-Based Behavioral Activation for Chronic Pain in Primary Care: A Pilot Study
Hooker, S. A., Slattengren, A. H., Boyle, L., & Sherman, M. D. (2019) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-019-09655-x · Cited by 12
Goal attainment scaling outcomes in general inpatient rehabilitation: association with functional independence and perceived goal importance and difficulty
Churilov, I., Brock, K. A., Churilov, J. M., Sutton, E., Murphy, D., MacIsaac, R. J., & Ekinci, E. I. (2020) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-2675 · Cited by 11
“Goal attainment scaling (GAS), which measures the degree of this achievement (7) is performed in consultation with patients or their carers (7).”
BackgroundInfluential
Reaching for Peak Performance During Surgical Training: The Value in Assessment Tools and Critical Performance Measures
Louie, P. K., McCarthy, M. H., Albert, T. J., & Kim, H. J. (2020) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-20-00172 · Cited by 11
The importance of community and culture for the recruitment, engagement, and retention of Chinese American immigrants in health interventions
Tsai, W., Zhang, L., Park, J. S., Tan, Y.-L., & Kwon, S. C. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibab053 · Cited by 13
Goal-Setting in Multiple Sclerosis-Related Spasticity Treated with Botulinum Toxin: The GASEPTOX Study
Baccouche, I., Bensmaïl, D., Leblong, É., Fraudet, B., Aymard, C., Quintaine, V., Pottier, S., Lansaman, T., Malot, C., Gallien, P., et al. (2022) · Toxins · doi:10.3390/toxins14090582 · Cited by 13
“Goals should be set in accordance with the SMART approach, hence being specific, measurable, achievable, relevant, and timed [37].”
BackgroundMethod
Physical Therapists' Ability to Predict Future Mobility After Spinal Cord Injury
Chu, J., Harvey, L. A., Ben, M., Batty, J., Avis, A., & Adams, R. D. (2012) · Neurology Report · doi:10.1097/npt.0b013e3182462f4f · Cited by 11
“87) 14 (37) 10 (63) 8 (84) AIS A/B (n = 21) 1 (1-1) 3 (1-6) 4 (2-6) 0.”
Influential
A single-case experimental design investigation of collaborative goal setting practices in hospital-based speech-language pathologists when provided supports to use motivational interviewing and goal attainment scaling
Kucheria, P., Moore Sohlberg, M., Machalicek, W., Seeley, J., & DeGarmo, D. (2022) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2020.1838301 · Cited by 10
“Three of these phases (Problem Identification, Treatment Selection, and GAS Construction) are considered vital to goal setting with clients who have neurogenic challenges following ABI, while the fourth phase (Buy-in) is optional and dependent on client motivation and responsivity to engaging in therapy.”
BackgroundMethodInfluential
Determinants of information needs in patients with coronary artery disease receiving cardiac rehabilitation: a prospective observational study
Limpt, N. T. V., Asten, I. V., Traa, S., Brouwers, R. W. M., Spee, R. F., Lü, Y., Brini, A., Kop, W. J., & Kemps, H. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-068351 · Cited by 10
Implementation of best practice goal-setting in five rehabilitation services: A mixed-methods evaluation study
Baker, A., Cornwell, P., Gustafsson, L. A., Stewart, C. E., & Lannin, N. A. (2023) · Journal of Rehabilitation Medicine · doi:10.2340/jrm.v55.4471 · Cited by 10
“Key elements of best practice goal-setting include: a common goal focus across team members (3, 4); action planning, feedback and review of goals (2, 5); ensuring goals are meaningful and specific (6); and including the client in shared decision-making (SDM) throughout the goalsetting process (7).”
Background
Maximizing the Benefit of Respite for Dementia Caregivers: A Study Protocol Describing the Development & Evaluation of the Time for Living & Caring (TLC) Intervention
Utz, R., Caserta, M. S., Iacob, E., Sparks, C., Stark, L. A., Terrill, A. L., Thompson, A. D., & Wong, B. G. (2023) · OBM Integrative and Complementary Medicine · doi:10.21926/obm.icm.2304040 · Cited by 9
“A modified “SMART goals” framework (defined as goals that are specific, measurable, attainable, relevant, timely) [37, 38] provides a framework to guide caregivers through the process of goal setting or goal selection, and facilitates the three theoretical adaptive strategies: first, caregivers…”
Background
Rehabilitation interventions targeting the activity and participation of patient with neuromuscular diseases: what do we know? A systematic review
Silva, S. F., de Magalhães, H. L., de Deus, F. Â., Andrade, K. K. S., Lima, V. P., & Gaiad, T. P. (2024) · Arquivos de Neuro-Psiquiatria · doi:10.1055/s-0044-1779295 · Cited by 10
“Knowing that the goals should be drawn together, centered on relevant complaints for the patient and whether they are achievable, 16 directing rehabilitation to body functions that will certainly be lost by the natural history of NMD makes it impossible to achieve the goals.”
Evaluating the Efficacy of Time for Living and Caring: An Online Intervention to Support Dementia Caregivers’ Use of Respite
Iacob, E., Caserta, M. S., Donaldson, G. W., Sparks, C., Terrill, A. L., Thompson, A. D., Wong, B. G., & Utz, R. (2024) · Innovation in Aging · doi:10.1093/geroni/igae043 · Cited by 10
“Prompts guided caregivers to develop individual time-use goals that were SMART (specific, measurable, achievable, relevant, and time-based; Bovend’Eerdt et al., 2009), by first having them select a desired set of goals, and then asking whether they needed to optimize or refine those goals based on…”
Background
Translational Research in Pain and Itch
Ma, C., & Huang, Y. (2016) · Advances in experimental medicine and biology · doi:10.1007/978-94-017-7537-3 · Cited by 11
Evaluating the outcome of an individual functional therapy program focused on children with cerebral palsy and cerebral visual impairment: a multiple case study
Salavati, M., Rameckers, E. A. A., Waninge, A., Krijnen, W. P., van der Schans, C. P., & Steenbergen, B. (2017) · European Journal of Physiotherapy · doi:10.1080/21679169.2017.1374455 · Cited by 10
“Before beginning, individual goals based on items of the GMFM-88CVI and PEDI-NL-CVI were defined according to the SMART principle (specific, measurable, achievable, realistic/relevant and time) [34,35].”
Method
Principles of Rehabilitation
Futrell, M., & Rozzi, S. L. (2019) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2019.10.004 · Cited by 10
Family-Centered practice in a Brazilian rehabilitation network service
Antunes, A. A. M., & Vaz, D. V. (2021) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2021.02.003 · Cited by 10
Wheelchair Skills Education and Training for Children with Spina Bifida and/or Hydrocephalus and Their Parents: A Pilot Study
Gowran, R. J., Collins, M. B., McGlanaghy, J., Shanahan, E., & Cleary, Y. (2022) · Disabilities · doi:10.3390/disabilities2010009 · Cited by 10
“It is recommended that future research uses SMART goal setting to better account for children’s developmental stages as part of this process [87].”
Method
Radiology Resident Remediation: Five Important Questions to Ask
Liu, J., Yucel, K. E., & Bedi, H. S. (2016) · American Journal of Roentgenology · doi:10.2214/ajr.15.15551 · Cited by 10
“Do I or the Resident Know How to Fix the Problem? It is essential to have a plan of remediation that is specific, measurable, achievable, realistic, and timed (SMART) [30].”
Background
Giving hope, ticking boxes or securing services? A qualitative study of respiratory physiotherapists’ views on goal-setting with people with chronic obstructive pulmonary disease
Summers, R. H., Ballinger, C., Nikoletou, D., Garrod, R., Bruton, A., & Leontowitsch, M. (2016) · Clinical Rehabilitation · doi:10.1177/0269215516658937 · Cited by 10
Exploring interest and goals for videoconferencing delivered cognitive rehabilitation with rural individuals with mild cognitive impairment or dementia
Burton, R. L., O’Connell, M. E., & Morgan, D. (2016) · Neurorehabilitation · doi:10.3233/nre-161364 · Cited by 10
What psychological and physical changes predict patients’ attainment of personally meaningful goals six months following a CBT based pain management intervention?
Oliver, S., Fisher, K., & Childs, S. (2016) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1226415 · Cited by 10
“Participants applied this framework to set goals according to this framework, in consultation with trained clinicians.[34] Current achievement for each goal was rated as baseline ( 1).”
Method
SMART goals setting and biometric changes in obese adults with multimorbidity: Secondary analysis of a randomized controlled trial
Takahashi, P. Y., Quigg, S. M., Croghan, I. T., Schroeder, D. R., & Ebbert, J. O. (2019) · SAGE Open Medicine · doi:10.1177/2050312119858042 · Cited by 10
The role of self-leadership in service leadership
Shek, D. T. L., Ma, C. M. S., Liu, T., & Siu, A. M. H. (2015) · International Journal on Disability and Human Development · doi:10.1515/ijdhd-2015-0455 · Cited by 10
“A commonly used approach in goal setting is the ‘SMART’ principle, which suggests a goal that is ‘specific’, ‘measurable’, ‘achievable’, ‘realistic’ and ‘time-bound’, and can strengthen the motivation for action and increase the odds of goal attainment [26].”
Method
Navigating through technological landscapes : Views of people with dementia or MCI and their significant others
Rosenberg, L. (2009) · Figshare · Cited by 10
Five Challenges in Implementing Cognitive Remediation for Patients with Substance Use Disorders in Clinical Settings
Maurage, P., Rolland, B., Pitel, A., & D’Hondt, F. (2023) · Neuropsychology Review · doi:10.1007/s11065-023-09623-1 · Cited by 11
Training healthcare professionals to administer Goal Attainment Scaling as an outcome measure
Logan, B., Viecelli, A. K., Pascoe, E. M., Pimm, B., Robison, L. E., Johnson, D. W., & Hubbard, R. E. (2024) · Journal of Patient-Reported Outcomes · doi:10.1186/s41687-024-00704-0 · Cited by 9
“This provides practical insights which supplement the existing guidance from Turner-Stokes [10], Steenbeek [16] and Bovend’Eerdt [17].”
BackgroundMethod
Using behavioral skills training to teach goal setting for health behaviors
Beaulieu, M., Normand, M. P., & Miltenberger, R. G. (2024) · Behavioral Interventions · doi:10.1002/bin.2041 · Cited by 12
Change starts with the body: Interoceptive appreciation mediates the effect of mindfulness training on behavior change – an effect moderated by depression severity
Schuman‐Olivier, Z., Gawande, R., Creedon, T. B., Comeau, A., Griswold, T. R., Smith, L., To, M. N., Wilson, C. L., Loucks, E. B., & Cook, B. L. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116230 · Cited by 11
Impact of a Long-Term Home-Based Rehabilitation Program on Quality of Life, Balance, and Autonomy in Adults with Disabilities
Barría, P., Andrade, A., Yelincic, A., Córdova, B., Covarrubias‐Escudero, F., Cifuentes, C. A., & Appelgren, J. P. G. (2025) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk10010024 · Cited by 12
Post stroke rehabilitation based on SMART goals: a case study
Rehman, A., Berry, J., & Siddiqui, M. (2014) · Journal of Experimental and Integrative Medicine · doi:10.5455/jeim.101113.cr.004 · Cited by 9
“SMART goals are used for rehabilitation [8].”

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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