Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)

Brain Injury

Technology (e.g. robotics, assistive technology, mHealth)

IC5: A Guide to Best-Practice Interdisciplinary Goal Setting in Clinical Practice

Body of Abstract: Goal setting is crucial in the interdisciplinary rehabilitation of acquired brain injury (ABI), in promoting collaboration within teams, motivating service users and tracking progress (Gauggel & Hoop, 2004; Tucker, 2015). A wealth of literature has examined the importance of setting and regularly reviewing both patient-led and clinical goals within multi-disciplinary teams (MDTs). As a result, crucial processes have been defined that outline the “best-practice” approach, including the assessment of International Classification of Functioning, Health and Disability (ICF), Goal Attainment Scaling (GAS), and the Specific Measurable Achievable Relevant and Timed framework (Lexell & Brogardh, 2015; Turner-Stokes, Williams & Johnson, 2009; Schut & Stam, 1994).

Despite the literature on each of these components individually and collectively, there appears to be sustained confusion and misunderstanding regarding the application of this research to clinical practice (Kucheria, 2019; Prescott, Fleming & Doig, 2015; Plant et al., 2016). Due to time and resource constraints, as well as a lack of interdisciplinary collaboration on a process, goal-setting is often inefficient, inaccurate and poorly tracked.

This instructional course aims to outline the best-practice process for goal-setting in clinical neurorehabilitation practice, resolving confusion around terminology and interdisciplinary collaboration. The course will address barriers to change that can prevent the adoption of new goal-setting practices, and suggest avenues of change. Understanding the difficulty of applying theoretical procedures to clinical practice, the course will also offer an opportunity for operationalising the new skills learned with real-world clinical data.



The course will achieve this through the following topics:

1. Defining best practice in goal setting and operationalising this

Attendees will be introduced or reintroduced to the process of completing a functional assessment of a patient, developing goals using GAS based on the results of this assessment, then setting SMART objectives to outline the steps that individual clinicians intend to take towards addressing those goals.

The ICF will be presented as a method for assessing patients’ function, with an explanation of the perceived advantages and disadvantages of this. Attendees’ attention will be drawn to the issues raised in the session at the 2019 ACRM Conference entitled “’Reimagining’ the ICF with a view to Practical Applications and Clinical Communication”, with an intention to present some solutions to these difficulties which have emerged through clinical application of the ICF within goal setting since the conference.

Attendees will also be asked to consider the latest work in understanding the terminology of goal setting. In line with this, goals will be defined as over-arching ambitions for a patient to achieve in their lives as a result of engagement in neurorehabilitation; objectives will refer to the specific steps that each individual clinician in the team intends to take towards achieving the goal with the patient. Thus, the SMART framework will be applied to objectives, highlighting the requirement for the steps to be specific and to exist within defined parameters. Goal Attainment Scaling (GAS) will be discussed in terms of its advantages, disadvantages and use in clinical settings. Worked examples will be presented to reinforce this learning.

2. Reformulating existing practice to fit with new guidelines

Understanding that emerging guidelines are a departure from current practice, a discussion will be held around the barriers for implementing this in clinical practice where other goal-setting ideas are currently being followed. Attendees will be encouraged to share concerns with one another to receive and offer advice using their own clinical experiences. Issues such as EPR/EMR integration, service management change, information sharing, and time constraints will be touched upon.

3. Applying technology to clinical practice to facilitate goal setting

Software technology will be introduced to address issues raised regarding implementing best-practice goal setting to practice. Specifically, barriers of time constraints and limits on information sharing will be recognised as difficulties experienced by the presenters who work in clinical practice, and how this led to the development of goal setting software. The software facilitates the completion of a functional assessment (primarily, the ICF assessment) then allows clinicians to build GAS goals from the results of the assessment, before defining SMART objectives that outline the steps individual clinicians will take towards achieving that goal. Evidence will be presented on how this software overcomes barriers, such as time and cost limitations, to achieving best-practice goal setting in practice.

4. Real-world application of theoretical goal setting practice: utilising goal data to get better clinical outcomes

Attendees will be presented with a case study of a patient in neurorehabilitation, or invited to use their own data. They will be supported in completing a functional assessment of the patient and setting efficient, effective and meaningful goals for the patient using GAS goals and SMART objectives. They will be encouraged to try different methods of this, including manual management of different documents and software technology.

Attendees will be encouraged to consider the clinical implications of the goal data, with specific reference to how these data impact outcomes for patients.


Abbreviated Description: Goal setting is crucial in neurorehabilitation for encouraging collaboration in multi-disciplinary teams, motivating patients and tracking progress. The key components of good goal setting, however, are often misunderstood. This instructional course aims to outline the best-practice process for goal-setting in clinical neurorehabilitation practice, resolving confusion around terminology and interdisciplinary collaboration. The course will address barriers to change that can prevent the adoption of new goal-setting practices, and suggest avenues of change. Understanding the difficulty of applying theoretical procedures to clinical practice, the course will also offer an opportunity for operationalising the new skills learned with real-world clinical data.

Learning Objectives:

• Describe the importance of inter-disciplinary goal setting within neurorehabilitation.
• Describe the best-practice / gold-standard process of goal setting, including advantages of each stage
• Identify barriers in implementing the best-practice goal-setting processes in existing clinical practice, and possible avenues for overcoming these.
• Confidently use appropriate goal setting terminology and processes in clinical practice
• Apply software to increase the accessibility of best-practice goal setting to clinical practice.