Why most rehab goals cannot be scored

A goal that cannot be scored at the end was almost always unscoreable the day it was written.

Three ways it fails

Nearly every unusable goal fails in one of three ways, and all three are visible in the sentence itself.

Nothing to measure

“Patient will improve ambulation.” There is no number, so there is no point at which this is met. At discharge there is no fact of the matter about whether it happened, and the honest answer to “was the goal achieved” is that the question does not have one.

No deadline

“Patient will transfer sit to stand with minimal assistance 4 out of 5 trials.” Perfectly measurable, and open-ended. There is no moment at which it is met or not met, so it persists, getting copied from note to note until the episode ends.

No assistance level

“Patient will walk 150 feet.” With two people? With a rollator? With nothing? Those are very different outcomes and the sentence does not distinguish between them, which means two clinicians can both be right about whether it was achieved.

The test

One question settles it: could two clinicians looking at the same person disagree about whether this had been achieved?

If yes, something is missing. Usually a number, sometimes a condition, occasionally both. The test takes a second and catches nearly everything.

Words that look like measurements

Some words feel like they are specifying something and are not. They occupy the position in the sentence where a measurement belongs, which is exactly what makes them hard to notice — the sentence reads as though it says something definite.

• improve, increase, decrease — from what, to what?
• tolerate — for how long, doing what?
• as tolerated, as needed, PRN — cannot be scored at all
• maximise, optimise — there is no end point
• within normal limits, WFL — normal for whom, judged how?
• demonstrate understanding — shown how?
• good technique, adequate, appropriate — judged against what?

None of these is banned. Each simply needs the number it is standing in for.

Activity or impairment

“Increase right knee flexion to 120 degrees in three weeks” is measurable, has a deadline, and is a perfectly legitimate goal. It is also not a functional one: it describes a measurement of the body rather than something the person does.

Impairment goals are not a mistake and often belong in a plan. The point of noticing is that the more useful question is usually what that impairment is stopping the person doing — and if the answer is climbing the stairs to their bedroom, that is the thing worth writing down, with the range of motion as one route to it.

A plan made entirely of impairment goals is a plan that has not said what any of it is for.

The five parts

A goal that can be scored generally contains all of these:

1. The activity — what the person will be doing. An activity, not a movement.
2. The conditions — equipment, surface, setting. With a rollator, on level ground, in the kitchen.
3. The assistance or cueing level — how much help, from supervision through to independent.
4. The measurable criterion — a number with a unit. Metres, minutes, repetitions, trials out of trials.
5. The time frame — by when.

Put together: “Will ambulate 150 feet with a rolling walker on level ground with supervision within four weeks.” Five components, one sentence, and no ambiguity at the end about whether it happened.

What structure does not buy you

A goal can contain all five components and still be a poor goal. Whether it is the right goal, whether the number is achievable, whether it measures something that matters to the person, whether it belongs in the plan at all — those are the questions that make a goal good, and none of them is visible in a sentence.

Structure is the floor, not the ceiling. It is worth checking because it is cheap to check and because a goal that fails on structure cannot be rescued later, but passing it means only that the goal is scoreable — not that it is worth scoring.

Frequently asked questions

What makes a goal impossible to score?

No number in it. “Patient will improve ambulation” has no point at which it is met, so at discharge there is no fact of the matter about whether it happened.

What is the quickest test?

Could two clinicians looking at the same person disagree about whether it had been achieved? If yes, something is missing — usually a measurement, sometimes a condition.

Why are words like “tolerate” and “improve” a problem?

They sit where a measurement belongs, so the sentence reads as though it says something definite when it does not. None is banned; each needs the number it is standing in for.

Are range-of-motion goals wrong?

No, and they often belong in a plan. They describe a measurement of the body rather than something the person does, so the more useful question is usually what that impairment is stopping them doing. A plan made entirely of impairment goals has not said what any of it is for.

What are the five components?

The activity, the conditions, the assistance or cueing level, a measurable criterion, and a time frame. Together they make a goal scoreable.

Does a goal with all five components mean it is a good goal?

No. Whether it is the right goal, achievable, or measures something that matters to the person are the questions that make a goal good, and none is visible in a sentence. Structure is the floor, not the ceiling.