Quality of Goal Setting in Pediatric Rehabilitation-A SMART Approach

Bexelius A, Carlberg EB, Löwing K. Quality of goal setting in pediatric rehabilitation-A SMART approach. Child Care Health Dev. 2018 Nov;44(6):850-856. doi: 10.1111/cch.12609. Epub 2018 Aug 15. PubMed PMID: 30112766.

Background
Setting goals for treatment is often the core of the rehabilitation process. The quality of the set goals has however rarely been evaluated. The aims of this study were therefore to assess the quality of goals set in clinical practice of pediatric rehabilitation using SMART criteria (Specific, Measurable, Achievable, Relevant, and Timed) and to assess if the goals were considered relevant from both a client perspective and expertise perspective.

Methods
In a retrospective multicase study, a total of 161 goals from 42 children with disabilities (cerebral palsy, n = 22; Down syndrome, n = 16; and developmental disability, n = 4) were assessed. The children were 1.5–5.5 years and had previously participated in goal‐directed, activity‐focused therapy at four pediatric rehabilitation centers. Collaborative goal setting had been used to define the desired treatment outcome. The quality of the goals was assessed using defined SMART criteria.

Results
Specific: All goals could be reliably linked to International Classification of Functioning, Disability and Health—Children and Youth version chapters within the Activity/Participation domain. Measurable: A total of 75% of the goals were rated as having a well‐defined scaling; in 20%, the scaling was less clear, and in 5%, a scaling could not be determined. Achievable: A total of 80% of the goals were attained. Relevant: All goals were set in collaboration with the family and could therefore be considered relevant from a client perspective. Relevancy judged from a professional perspective was strengthened by the fact that age, baseline status, and diagnosis had an influence on the choice of goals. Timed: All goals were set within a specific time frame.

Conclusions
The goals set in clinical practice showed high quality with respect to the SMART criteria. The most difficult part was the construction of the goal attainment scale. The goals settled in clinical practice were considered relevant from both a client perspective and expertise perspective.

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