As our healthcare system continues to evolve, it will be
even more important for us to not only maintain quality of
care for our patients but to ensure reimbursement for our
services as well. One step that we can take to maximize
outcomes for both parties is to facilitate an increase in
patient participation with physical therapy goal setting.
“Patients are likely to make the greatest gains when therapy
and the related goals focus on activities that are
meaningful to them and will make a difference in their lives
(1)”. This can translate to an enhancement in patient
compliance which can lead to better patient outcomes.
According to Guide to Physical Therapist Practice (2),
physical therapists are expected to involve the patient (and
family members and significant others, if appropriate) when
establishing goals and outcomes. The goals and outcomes
should be stated in measurable terms. They should be related
to impairments, functional limitations, and disabilities and
changes in health, wellness, and fitness needs identified in
the examination. In addition, health care policy,
reimbursement practices, and the standards of accrediting
bodies also recognize the value of working toward achieving
abilities that are meaningful to patients and increasingly
require the goals of physical therapy and other professional
services to be patient-centered and functional (1).
As physical therapists, we may think that we have developed
a collaborative relationship with our patients when we are
developing patient centered goals, but are we doing enough?
Baker et al (3) conducted a study to determine whether
physical therapists seek to involve patients in goal setting
and, if so, what methods they use. Their study involved
twenty-two physical therapists who had the initial
evaluations of 73 elderly patients audiotaped. The
audiotaped examinations were then scored using the
Participation Method Assessment Instrument to determine the
frequency of attempts made by physical therapists to involve
patients in goal setting. Their study found that in most
cases, the physical therapists did seek to involve their
patients in goal setting, but at levels that are less than
the potential that may exist.
So what steps can we take to help improve our goal writing
skills? Randall et al (1) found the following steps useful
to identifying goals with patients: 1) determine the
patient’s desired outcome of therapy, 2) develop an
understanding of the patient’s self-care, work, and leisure
activities and the environments in which these activities
occur, and 3) establish goals with the patient that relate
to the desired outcomes. If patients can’t express their
needs, family members or significant others may do so for
them.
Once we have determined the general outcomes desired by the
patients we need to translate these desired outcomes into
patient centered goals which are time bound, measurable and
functional (1, 2, 3, 4). By writing patient centered goals this
will help us to better conform to health policy, to be
reimbursed for interventions, to assist in meeting the
expectations of accreditation process and legislation, and
ultimately to meet the unique needs of our patients (1).
Last revised: November 11, 2009
by Chai Rasavong, MPT, MBA
