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Goal Writing

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  • Goal Writing

    Hi everyone,

    Full disclosure: I submitted this to the JOSPT blog a week or so back. If there are any students or practicing clinicians here I'd appreciate any feedback.

    The Goal Writing Physical Therapist
    Goal writing is a staple of physical therapy practice. Writing goals is taught and used daily for clinical documentation. It is a practice I started questioning after I was asked to write, edit…then edit again in school and during clinical rotations. To this day I struggle to understand why and how it ever became part of physical therapy practice. As a physical therapist, I care about outcomes. Despite those who may support or advocate for goal writing, I’ve failed to see convincing evidence it has a relevant impact on relevant outcomes. 1,2

    No practicing physical therapist enjoys documentation.3 No practicing physical therapist enjoys the required act that is; creative writing (otherwise known as “skilled services” and “medical necessity”) . Who gets joy when their quarterly chart audit shows up in their inbox? Physical therapy professors, students, and clinical instructors spend HOURS on documentation of goals despite its lack of impact on relevant outcomes.

    Anecdotally, I’ve visited primary care physicians, specialists, dentists, etc and have never been asked “what are your goals?” Having read countless notes from all healthcare specialties I have yet to read:
    “Patient will floss upper and lower level canines daily and independently to improve dentition”
    “Patient will consume metformin with 50% accuracy to improve fasting glucose levels by 5%”

    New Evidence on Goal Writing
    I recently performed an uncontrolled, anecdotal, two question survey of licensed physical therapists. The purpose was to assess the knowledge and attitudes towards goal writing in outpatient musculoskeletal physical therapy practice. The results were eye opening! 3

    Average years of experience: 25 years (6-41 years)

    Why do physical therapists write goals?
    “I don’t know.”
    “Because we’ve always done it.”
    “I guess I never really thought about it.”

    How would you feel if you were allowed to discontinue goal writing?
    “That would be awesome!”
    “Wait, are you saying we can stop writing goals?!!”
    “Sign me up!”

    Something we can agree on???
    Take one look at physical therapy related social media, forums or podcasts and you’ll inevitably become a sideline observer to debate, arguments, discussion of who’s right, wrong, evidence or science-based. Citations and accusations will be lobbed back and forth. Taking offense will occur, feelings will get hurt. Neither side will relent. Both remain stead-fast in their methods and beliefs. Both sides proclaim victory while holding tighter to their confirmation bias. Each side then retreats to writing editorials or social media posting to declare victory. 4 The cycle soon repeats itself….

    So what can physical therapists agree on? If critical thinking, reasoning, interpretation of science and evidence is so divided, where can this community of healthcare professionals come together? Maybe just maybe I’ve convinced you its goal writing.

    In Summary
    Satire aside; what sense does it make to write a goal for someone else?

    We know the patient’s goal:

    I don’t want to feel the way I’m feeling.
    I can’t do what I like to do the way I want to do it.
    I want my headache/cancer/disease/pain to go away.

    I’ve yet to meet a full time physical therapist that enjoys writing goals. Would they lose sleep if they showed up to the clinic and were informed they could stop writing goals? Take a moment for a simple thought experiment: Tomorrow you can stop writing goals. Meditation can’t touch that level of euphoria.

    Would your patient outcomes suffer? Would your patient demand you write goals for them? Would you become less of a clinician? The answer is clearly no. So why continue the creative writing when the goals are crystal clear?

    So someone please help me. Why continue a practice when it doesn’t improve relevant physical therapy outcomes? My bias believes the answer falls somewhere between “someone somewhere at sometime thought it mattered” and “because it’s tied to getting paid.”

    Levack, William MM, et al. "Is goal planning in rehabilitation effective? A systematic review." Clinical rehabilitation 20.9 (2006): 739-755.
    Randall, Kenneth E., and Irene R. McEwen. "Writing patient-centered functional goals." Physical Therapy 80.12 (2000): 1197-1203.
    Rupiper, M et al. “Goal Writing Perceptions Amongst Experienced Physical Therapists; a quantitative survey. The Central Illinois Journal of Physical Therapy Practice. Predatory Publishing, Vol. 1, pg 1-2.
    Cook, Chad E., et al. "Benefits and threats to using social media for presenting and implementing evidence." Journal of Orthopaedic & Sports Physical Therapy 48.1 (2018): 3-7.

    Matthew Rupiper, PT, DPT, OCS
    "The author declares no competing interests”
    “Views and opinions are my own and do not reflect those of my employer.”