SMART goals in physical therapy: how to write them, with examples

SMART goals in physical therapy are goals that are specific, measurable, achievable, relevant and time-bound. A good one names an activity the patient cares about, the number that shows it has been reached and the date you expect to get there, for example "climb the 14 stairs at home step over step, one hand on the rail, with knee pain no higher than 3 out of 10, within 10 weeks". Write the goals with the patient and put them in the plan of care. The home exercise program (HEP) is then built toward them.

First, a short history of the acronym and what the research on goal setting in rehab shows. After that comes a simple formula, then short-term and long-term goals for three example patients. The last part links goals to your notes and the HEP and lists the mistakes that make a goal useless.

What does SMART stand for?

Letter	What it asks	In the stairs goal above
Specific	Which activity, and where?	The 14 stairs at home, step over step
Measurable	What number shows it is done?	One hand on the rail, pain 3 out of 10 or lower
Achievable	Can this patient get there in the time and visits available?	Based on the assessment and how she manages stairs now
Relevant	Does it matter to the patient?	Her bedroom is upstairs
Time-bound	By when?	Within 10 weeks

The acronym comes from management, not healthcare. George Doran introduced it in a two-page article in Management Review in 1981, as a way for managers to write objectives. In his version, as later papers quote it, the letters stood for specific, measurable, assignable, realistic and time-related.

Rehab adapted the words. Bovend'Eerdt, Botell and Wade wrote a practical guide for rehabilitation teams in 2009 and used specific, measurable, achievable, realistic or relevant, and timed. You will see other mixes too, such as attainable for achievable. The letters matter less than the result: a goal two clinicians would both score the same way on the same day.

Does goal setting improve rehab outcomes?

The main summary of the evidence is a 2015 Cochrane review by Levack and colleagues on goal setting for adults in rehabilitation after an acquired disability. It included 39 studies with 2,846 participants in total. The most common conditions were musculoskeletal disorders, brain injury, chronic pain, mental health conditions and cardiovascular disease. The search ran to December 2013.

Compared with no goal setting, there was very low quality evidence that any type of goal setting improved health-related quality of life or self-reported emotional status, a moderate effect across 8 studies. The same very low quality evidence pointed to better self-efficacy, the patient's confidence in their own ability, a moderate to large effect across 3 studies. The results were inconclusive for activity levels, social participation, body structure and function, and how engaged patients were in their rehab.

Structured goal setting was also compared with usual care. It gave slightly higher self-efficacy (very low quality evidence) and slightly greater satisfaction with the service (low quality evidence). The authors concluded there is some very low quality evidence that goal setting may improve some outcomes. The best of it favors quality of life, emotional status and self-efficacy rather than physical outcomes, and further research is highly likely to change the estimates.

So goal setting is not a treatment with a known effect on function. It is a way for you and the patient to agree in writing on what you are working toward, so both of you can see whether the plan is working. The review also notes there is little consensus on the best way to set goals. SMART is one format among several.

Setting goals with the patient, not for them

A goal the patient did not choose is your goal, not theirs. Melin and colleagues analyzed 21 articles on person-centered goal setting in physiotherapy. Two of the five categories they found were understanding which goals are meaningful to the patient and setting goals in collaboration. They described person-centered goal setting as "a process of interaction toward a mutual understanding of what is meaningful to the patient".

NICE puts the same idea into its 2021 guideline on shared decision making (NG197). It asks clinicians to encourage people to think about what matters to them, and to discuss how the aims of each option fit with the person's own aims, priorities and wider goals.

A common way to start is an open question: "What would you like to be able to do again that you can't do now?" Write the answer in the patient's words, then add the number and the date together. If the patient's aim is bigger than one episode of care, such as a first half marathon after knee pain, the long-term goal becomes a step toward it. That is where achievable and relevant meet.

The Patient-Specific Functional Scale as a goal measure

Stratford and colleagues described the Patient-Specific Functional Scale (PSFS) in Physiotherapy Canada in 1995. The patient lists the activities that have become difficult and scores each one on an 11-point scale. The two ends of the scale are 0, "unable to perform", and 10, "able to perform at the level before the problem". The Shirley Ryan AbilityLab database lists it as taking less than 4 minutes.

The patient picks the activities, so each one can become a goal with a baseline score already beside it. "Walking to the shops: 4 out of 10 now, 7 or higher by week 10" is specific, measurable and relevant in one line. A separate guide on the PSFS, with the scoring rules and the research on how much change matters, is on the way.

How to write a SMART goal: a four-part formula

Bovend'Eerdt and colleagues build each goal from up to four parts: the target activity, the support needed, how well the activity is done, and the time period. Their aim was to make goal writing quicker and more consistent across a team. As a template:

"[Patient] will [activity] [with this support] [to this standard] by [date or number of weeks]."

Part	What to write	Example
Activity	A task from the patient's own life	Walk to the shops and back
Support	Aids, rails, another person, or none	Without a stick
Standard	Distance, time, reps, pain limit or a score	About 20 minutes each way, knee pain 3 out of 10 or lower
Time	Weeks from today, or a date	By week 10

Add one more thing the template leaves out: the baseline. A goal of 20 minutes means little unless the note also says the patient manages 10 minutes today. Record how you measured it, too, so the next check uses the same method.

Short-term and long-term goals in physical therapy

Long-term goals describe where the patient should be at the end of this episode of care. They are usually about function: stairs, work, sleep, sport, lifting a child. Short-term goals are the steps on the way, often set a few weeks apart. That spacing is common practice, not a rule.

A short-term goal can target an impairment, such as knee bend or grip strength, as long as it clearly leads to a long-term goal. "Knee bend to 110 degrees" on its own tells the patient little. Next to "so you can climb stairs step over step", it explains why the exercise is in the program. When a short-term goal is met, set the next one. When it is missed, the note should say why.

Worked examples: SMART goals for three patients

Mrs. R, Mr. T and Ms. J are invented, for illustration only. None of them is a real person, and their numbers and time frames show how a goal is written, not what a real patient should expect. Your own goals come from your assessment and change as the patient responds. Patients reading this: your physio will set goals with you and change them as you go.

Knee osteoarthritis: Mrs. R, 66

Mrs. R has knee osteoarthritis in her right knee. Her bedroom is upstairs and she takes the 14 stairs one at a time, both hands on the rail, with pain of 5 out of 10 coming down. She stops after about 10 minutes of walking, and she pushes up with both hands to get out of a dining chair. Her PSFS scores are 3 out of 10 for stairs and 4 for walking to the shops.

Goal	What you write
Long-term, week 10	Climb and come down the 14 stairs at home step over step, one hand on the rail, with knee pain no higher than 3 out of 10 (PSFS stairs 7 or higher)
Long-term, week 10	Walk to the shops and back, about 20 minutes each way, without stopping, knee pain no higher than 3 out of 10
Short-term, week 3	Stand up from a standard dining chair 10 times in a row without using her hands, knee pain no higher than 3 out of 10
Short-term, week 4	Walk 15 minutes on the flat without stopping, 3 days a week, with any ache back to usual by the next morning

Each exercise in her HEP points at one of these. Sit to stand works toward the chair goal and, later, the stairs. The step up trains the stairs directly, and brisk walking builds toward the shops. The 3 out of 10 pain limit is a cautious choice for the example, not a research figure.

Low back pain: Mr. T, 41

Mr. T has had low back pain for 6 weeks after lifting at home, with no leg symptoms and a clear red flag screen. He works at a desk and has a 3-year-old son who weighs about 15 kg (33 lb). He can sit for 20 minutes before he has to stand, and has stopped his weekend 5 km runs. His PSFS scores are 4 out of 10 for sitting through a work meeting and 2 for lifting his son from the floor.

Goal	What you write
Long-term, week 8	Lift his son (about 15 kg, 33 lb) from the floor whenever needed through the day, back pain no higher than 2 out of 10 (PSFS 8 or higher)
Long-term, week 10	Run 5 km at an easy pace on a weekend morning, with back pain no worse the next day
Short-term, week 2	Sit through a 45-minute work meeting without needing to stand
Short-term, week 4	Lift a 10 kg (22 lb) box from the floor to a table 5 times, back pain no higher than 3 out of 10 and settled by the next morning

His HEP might include the bird dog and the glute bridge for trunk and hip strength, with brisk walking as the first step back toward running. The lifting goal at week 4 is a practice version of the long-term goal with a lighter, steadier load.

Shoulder pain: Ms. J, 54

Ms. J has had rotator cuff tendinopathy in her right shoulder for 4 months. Reaching overhead hurts at 6 out of 10, she struggles to put things on the top kitchen shelf, and she wakes most nights when she rolls onto that side. She used to swim twice a week. Her PSFS score for the top shelf is 3 out of 10.

Goal	What you write
Long-term, week 12	Lift a 1 kg (2.2 lb) bag of flour onto the top kitchen shelf 5 times, shoulder pain no higher than 2 out of 10 (PSFS 8 or higher)
Long-term, week 12	Swim 20 minutes of breaststroke twice a week, with no shoulder pain that lasts into the next day
Short-term, week 4	Lift the same bag to a shelf at shoulder height 10 times, pain no higher than 3 out of 10
Short-term, week 6	Sleep through at least 5 nights a week without waking from shoulder pain

Her HEP could start with side-lying external rotation, then shoulder external rotation with a band and wall slides with a towel to rebuild reaching. The long-term goals sit at 12 weeks because the rotator cuff tendinopathy page uses a window of about 12 weeks to judge whether a program is working. A tendon goal set for 2 weeks would likely be missed even with good care.

Where goals go in the SOAP note and plan of care

Goals belong in the plan of care from the first visit. In the documentation guidelines from the American Physical Therapy Association (APTA), the plan includes "overall goals stated in measurable terms that indicate the predicted level of improvement in functioning". At a re-examination, the guidelines expect you to interpret the findings and revise the goals when needed. The discharge summary records the degree of goals achieved and the reasons any were not.

In a SOAP note, the goals are set in the plan at the first visit. In each follow-up, the assessment section reads the new findings against them: is the patient on track, and if not, why? The SOAP notes guide has a worked follow-up note with the goal carried in the plan.

Goals in the Medicare plan of care (USA)

For outpatient physical therapy under Medicare, the federal regulation (42 CFR 410.61) says the plan of treatment indicates the diagnosis and anticipated goals. Section 220.1.2 in chapter 15 of the Medicare Benefit Policy Manual lists the minimum contents of the plan as the diagnoses, long-term treatment goals, and the type, amount, duration and frequency of therapy services.

The same section says long-term goals should be developed for the entire episode of care in the current setting. Goals should be measurable and pertain to identified functional impairments. The manual says therapists typically also set short-term goals, such as goals for a week or a month, and lists them as an optional element of the plan. Changing a short-term goal to keep up with progress toward the same long-term goal counts as an insignificant change, while a change in long-term goals counts as significant. If measurable goals cannot be reached, for example because care is unexpectedly cut short or a flare-up of the condition ends the episode, the manual asks the documentation to state the clinical reasons progress cannot be shown.

That is a summary of what the manual says about goals, not billing or coverage advice. Check the current manual, your Medicare Administrative Contractor and each payer's own rules. Outside the USA, the record rules come from local insurers and regulators, and those come first.

How goals shape the home exercise program

Every exercise in a HEP should trace back to a goal. If you cannot say which goal an exercise serves, ask whether it needs to be there. Nobody has tested this as a rule. It is how many physios work, and it tends to keep the program short. For picking the exercises and deciding how many to give, see the home exercise program guide.

The goal also points the dose in a direction. How to set the dose itself is in the FITT principle guide. When to step up or down is in the exercise progression guide, which says every progression ladder needs a destination. The long-term goal is that destination.

Tell the patient which goal each exercise is for. "This one is for the stairs" gives them a reason to do it on a tired evening. PocketPhysio has a cue field on every exercise, next to the dose you set, and that one line fits there. Patients get the program by link, SMS or email, or through the Pocket Physio Care app, and WhatsApp works too. They follow a video with a spoken voice guide for each exercise.

Measuring progress toward a goal

A goal is only useful if the measure behind it can be repeated. Use the same test in the same set-up at baseline and at each review, and write the method in the note. Pair a patient-chosen measure, such as the PSFS, with a performance test where one fits, such as timed stairs or a chair stand count.

At each review, mark every goal as met, partly met or not met, and write one line on why. A missed goal is information: the time frame was too short, the dose too low, something else got in the way, or the diagnosis needs another look. The outcome measures guide covers which tests to pick and how to use them.

Common mistakes with SMART goals

1. Goals the patient never agreed to. If the patient cannot say what their goals are, they were probably set for them.
2. Impairment goals with no link to function. "Shoulder flexion to 160 degrees" needs a reason beside it, such as reaching the top shelf.
3. No baseline. "Walk 20 minutes" cannot be judged without today's number.
4. Vague words. "Improve", "tolerate", "as able" and "independent with HEP" cannot be measured without a number or a standard.
5. A time frame that ignores the condition, such as 2 weeks for a long-standing tendon problem.
6. Pain at zero as the only goal. A goal that depends on no pain at all can be missed even when the patient is back to everything they wanted. Pair a pain limit with an activity.
7. Too many goals. Many physios keep to two or three long-term goals the patient can remember, rather than eight they cannot.
8. Set once, never read again. The APTA guidelines expect goals to be revised at re-examination when needed.
9. Measuring differently each time. A range of motion figure taken sitting one week and lying the next cannot show progress.

When a goal should wait

A goal is never a reason to push through warning signs. Teach every patient the signs below. Each one means stop and get help, whatever the goal or the program says:

1. Chest pain or pressure, dizziness or feeling faint, a racing or irregular heartbeat, or being far more out of breath than the effort should cause.
2. Your calf or thigh becomes swollen, warm, tender, red or darker than usual, or has a throbbing or cramping pain that feels different from normal muscle ache. Stop and get medical advice the same day, as this can be a blood clot. If you are also short of breath or have chest pain, call emergency services.
3. Pins and needles, numbness or weakness in an arm or leg that does not go away after you stop. Get medical advice the same day. If one side of your face or body suddenly goes numb or weak, or your speech becomes slurred or muddled, call emergency services, even if it goes away.
4. Numbness around your genitals or bottom, new trouble with your bladder or bowels, pain, tingling, numbness or weakness in both legs, or loss of feeling in one leg. Call emergency services or go to an emergency department straight away.
5. Your leg or foot gets weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
6. Sharp pain during an exercise, or pain or swelling that is clearly worse the next day. Stop that exercise and check with your physio before you do it again.

If chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked. If you faint while exercising, call emergency services, even if you feel fine again quickly.

New symptoms mean a reassessment first, and the goals are revised after it. After surgery, the surgeon's protocol sets the time frames, and a goal date should never run ahead of it. With a heart or lung condition, the medical team decides how hard the patient works toward a goal.

The short version

SMART goals in physical therapy are specific, measurable, achievable, relevant and time-bound, and the patient should help write them. Build each one with the four-part formula above, and record the baseline beside it. Set long-term goals for the end of the episode and short-term steps toward them, then tie every HEP exercise to one of them. Evidence that goal setting improves function is uncertain, but a clear goal still tells you and the patient whether the plan is working.

References

1. Doran GT. There's a S.M.A.R.T. way to write management's goals and objectives. Management Review. 1981;70(11):35-36.
2. Bovend'Eerdt TJ, Botell RE, Wade DT. Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clinical Rehabilitation. 2009;23(4):352-361. doi:10.1177/0269215508101741
3. Levack WM, Weatherall M, Hay-Smith EJ, Dean SG, McPherson K, Siegert RJ. Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation. Cochrane Database of Systematic Reviews. 2015;(7):CD009727. doi:10.1002/14651858.CD009727.pub2
4. Melin J, Nordin Å, Feldthusen C, Danielsson L. Goal-setting in physiotherapy: exploring a person-centered perspective. Physiotherapy Theory and Practice. 2021;37(8):863-880. doi:10.1080/09593985.2019.1655822
5. National Institute for Health and Care Excellence. Shared decision making. NICE guideline NG197. Published 17 June 2021. https://www.nice.org.uk/guidance/ng197
6. Stratford P, Gill C, Westaway M, Binkley J. Assessing disability and change on individual patients: a report of a patient specific measure. Physiotherapy Canada. 1995;47(4):258-263. doi:10.3138/ptc.47.4.258
7. Shirley Ryan AbilityLab Rehabilitation Measures Database. Patient Specific Functional Scale. https://www.sralab.org/rehabilitation-measures/patient-specific-functional-scale
8. American Physical Therapy Association. Guidelines: Physical Therapy Documentation of Patient/Client Management. BOD G03-05-16-41, last updated 19 May 2014. https://www.apta.org/siteassets/pdfs/policies/guidelines-documentation-patient-client-management.pdf
9. Centers for Medicare and Medicaid Services. Medicare Benefit Policy Manual (Pub. 100-02), Chapter 15: Covered Medical and Other Health Services. Section 220.1.2, Plans of Care for Outpatient Physical Therapy, Occupational Therapy, or Speech-Language Pathology Services. Accessed September 28, 2026. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf
10. Code of Federal Regulations. 42 CFR 410.61, Plan of treatment requirements for outpatient rehabilitation services. Accessed September 28, 2026. https://www.law.cornell.edu/cfr/text/42/410.61

Written and checked by the PocketPhysio editorial team. Last updated 2026-09-28.