All conscious human behaviour is in pursuit of some goal, according to goal setting theorists Locke and Latham.

They believe that goals can be help a person by:

• directing their attention and effort towards a specific outcome
• enhancing their persistence
• giving them energy and motivation
• helping them develop new strategies.

In a rehabilitation context, goal setting involves the client and their rehabilitation providers devising a set of desired outcomes that the client intends to work towards achieving.

Generally, goals are individualised for each person as a pre-set list may fail to give a complete picture of the client’s needs.

The client, in conjunction with the rehabilitation team, should first establish what they hope to achieve. Next, the team should help the client establish what changes are actually possible.

The final set of goals should reflect a balance between the client’s desires and the reality of their situation.

Goals should take into account the patient’s history, family situation and pathology, as well as any other factors which impact on their progress. Both short term and long-term goals should be considered.

A SMART approach

The SMART model is a guide to formulating goals. It suggests that a goal should be specific, measurable, attainable, relevant and timely.

Attainability is a controversial criterion. Locke and Latham argue that a difficult goal is more likely to result in a higher level of effort than an attainable one. This may create better overall improvement in the client’s condition even if the goal is not achieved.

This view has been criticised by rehabilitation professionals, who argue that unrealistic goals are likely to demoralise clients. On the other hand, rehabilitation providers must ensure that they do not crush a client’s hopes by dismissing their goals as impossible.

The “M” in SMART, referring to measurability, has also been the source of controversy.

A goal should be measurable so that the patient and their team have a way of determining if the goal has been achieved.

To assist in measuring success, Kiresuk & Sherman developed a goal attainment scale, where benchmarks indicate what would constitute achievement of each goal. The client and provider revisit the scale at the end of a set time period to determine whether the patient has over or under achieved.

The client can gain a sense of satisfaction and achievement by this process, but there is also the risk of deflating a client who is disappointed by their outcomes.

Derrick Wade, the editor of Clinical Rehabilitation, argues that not all goals require quantification. A rehabilitation provider could risk losing the benefit of an abstract objective by focusing only on goals that can be measured.

For example, “be more patient with my children” may be a worthwhile goal even if it is difficult to quantify.

Other challenges to rehabilitation providers can include patients who lack the cognitive abilities to set goals or clients who become de-motivated by set-backs.

It can also be difficult to transfer goals from a rehabilitation setting to the client’s real life, where they are faced with demands that may be incompatible with their goals.

Ultimately, goal setting is a valuable exercise, especially if multiple teams are involved in the rehabilitation process. However, strict adherence to guidelines may alienate the patient and make them resistant to rehabilitation as a whole.

At the end of the day, whether a client feels empowered by their progress may be more important than whether they can tick off a specific goal.