Setting a SMART goal for

Movement & therapeutic

exercise in Pediatric
Rehabilitation
PIT Perdosri Jatim 2021
Ratna D Haryadi Soebadi
Departemen IKFR FK Universitas Airlangga / RSUD & Pendidikan Utama Dr Soetomo
Ratna D Soebadi PIR Perdosri Jatim 2021 1
 SMART
GOALS

Principles for
prescribing
exercise

Ratna D Soebadi PIR Perdosri Jatim 2021 2

 S M A R T GOALS
Specific • The goal should state in clear terms what will be accomplished

Measurable The goal must be quantified or measurable

Attainable The goal must be attainable given available resources

Relevant The goal must be something important to achieve

The goal should state the time period in which it will be

Time bound
accomplished

https://youtu.be/06K-dQ5S_pI
Ratna D Soebadi PIR Perdosri Jatim 2021 3
SMARTER ( Wade, 2010)

Ratna D Soebadi PIR Perdosri Jatim 2021 4

 SMART Goal Setting Guide
Specific : clear and easy to understand

Measurable : measurement criteria

Attainable: Before you can add a number, you have to

know how high or low you want to go

Relevant: Set goals that are important to where

you are in your life right now

Time-bound: Set the time to reach the goal

Ratna D Soebadi PIR Perdosri Jatim 2021 5
What is specific for Children ?
• Growing and developing
• Proportion of COG , COM
• Hormonal
• Muscle bone fat composition
• Joint laxity
• Disease pattern
• FUN in the exercise
• Do not take too much time , enjoy life, ‘how much is enough?’
• Goal attainment scaling

Ratna D Soebadi PIR Perdosri Jatim 2021 6

Cochrane Rehabilitation 4th version of the provisional
Definition of REHABILITATION (Kiekens, Rathore ISPRM 2021)
• In a health context , Rehabilitation is a multimodal, person-centered
process, including interventions targeting a person’s capacity ( by
addressing body structures, functions, and activities/participation)
and/or contextual factors related to performance with the goal of
optimizing functioning of persons with health conditions currently
experiencing disability or likely to experience disability, or persons
with disability

Ratna D Soebadi PIR Perdosri Jatim 2021 7

 EBM : What is rehabilitation ?
(Derick Wade ; Clinical Rehabilitation 2020)
Background : There is no agreement about or understanding of what rehabilitation is;
by those who pay for it, provide it, and receive it. All have different interpretation.
Method, extract information from systematic reviews that find rehabilitation to be effective, to
discover key features, to develop an empirical definition

• Findings : rehabilitation may benefit any person with a long-lasting

disability, arising from any cause, at any stage of the illness, at any
age, and may be delivered in any setting.
• Conclusion : Effective rehabilitation is a person-centered process, with
treatment tailored to the individual patient’s needs , and,
• Importantly, personalized monitoring of changes associated with
intervention, with further changes in the person’s activity & participation
Ratna D Soebadi PIR Perdosri Jatim 2021 8
 What kind of a Goal
the clinical service set out to achieve goals that:
• are individualized to a particular patient; Personalized
• can be written without too much effort, time or specific training; Mudah
• allow accurate, unambiguous determination of goal achievement; Terukur
• are flexible enough to cover most situations Fleksibel

Ratna D Soebadi PIR Perdosri Jatim 2021 9

 FORMULATION of MEASURABLE GOALS
MUST KNOW
• The target activity (Aktivitas yg mau dirubah & apa yg hrs ditempuh utk merubah)
• The support needed
• Quantification performance
• The time period to achieve the desired state

This method can be employed as part of goal attainment scaling

Ratna D Soebadi PIR Perdosri Jatim 2021 10

 Goal attainment scaling
is particularly dependent on defining goals that are measurable,
which is not always easy because each goal requires several different
levels to be defined.

The success of goal setting and goal attainment scaling relies on the
FORMULATION OF THE GOALS

Ratna D Soebadi PIR Perdosri Jatim 2021 11

 A SMART GOAL IN REHABILITATION
( Clin.rehabil. 2010 Apr;(4):382)

• Specific : A specific condition or target activity clearly

stated
• Measurable : Quantifiable by an indicator of progress
• Achievable : the realistic possibility to achieve this goal
• Relevant : the usefulness of this goal for the patient
• Timed : Can be reached within a time frame

Ratna D Soebadi PIR Perdosri Jatim 2021 12

 Rehabilitation is concerned with
Changing Behaviour

ICF
ACTIVITY LIMITATION
The goal is to increase a patient’s
behavioural repertoire as much as possible,
within any constraints imposed by disease and
impairments
Ratna D Soebadi PIR Perdosri Jatim 2021 13
 Model for treatment
Aspects of health

Cerebral Palsy

functions activity participation

Muscle force Walking without support Gymnastics at school

Possibilities
External factors and positive factors
Personal factors
Helpful teacher at school Strong motivation
International Classification of Functioning,
Disability and Health for Children and Youth (WHO,
Ratna D Soebadi PIR Perdosri
2007)Jatim 2021 14
 need need need Activities
parents child team Participation

Participation
assessment Activities
Body functions

treatment goal Participation

Activities

treatment options Body functions

Participation
treatment plan activities

Body functions
treatment Act/participation

Participation
Activities
evaluation
Ratna D Soebadi PIR Perdosri Jatim 2021 Body functions 15
 GOAL SETTING IN REHABILITATION
(Physiopedia & Wade 2010)

The formal process whereby a Rehabilitation

professional or a multidisciplinary team, together
with the patient and /or the family negotiate goals
• A fundamental part of the Rehabilitation process
• Is the intended outcome of a specific set of
interventions
•
Ratna D Soebadi PIR Perdosri Jatim 2021 16
 A GOAL in Rehabilitation
(Wade D. Goal setting in Rehabilitation. Clinical rehabilitation 2009; 23:291-295)

• Benefits :
vMotivating the patient,
vgreater client COMPLIANCE & improved PERFORMANCE
vcoordinate activities towards a common goal
vEnsure all necessary goals are identified
vnothing is missed or duplicated result in EFFICIENCY of
RESOURCES & TIME
vcan be used to evaluate the success of Rehabilitation
intervention

• A goal should not necessarily be completely SMART

Ratna D Soebadi PIR Perdosri Jatim 2021 17
 The Goals in Rehabilitation
• Directed towards achievable & meaningful outcomes
• 2 important components :
• An intended future state
• the effort to reach that state : a set of interventions

• 2 characteristics :
• An intended future state that involves a change from the current situation
or
• In some circumstances : maintenance of a current state in the face of
expected deterioration

Ratna D Soebadi PIR Perdosri Jatim 2021 18

What is needed to establish the goal ?
( Wade, 2009)
• Establish the patient’s goal
• Do not make assumptions about wishes & expectations
• Wishes & expectations of other parties, i.e. Family, carer, colleagues
at work
• Funding
• What changes are possible
• What would be needed to achieve each goal
• How likely the change is to occur

Ratna D Soebadi PIR Perdosri Jatim 2021 19

Ratna D Soebadi PIR Perdosri Jatim 2021 20
Ratna D Soebadi PIR Perdosri Jatim 2021 21
Ratna D Soebadi PIR Perdosri Jatim 2021 22
Ratna D Soebadi PIR Perdosri Jatim 2021 23
Ratna D Soebadi PIR Perdosri Jatim 2021 24
 Take home messages
A Goal in Rehabilitation

• should be the INTENDED RESULT of INTERVENTION(S) undertaken by the

REHABILITATION TEAM

• The goal setting process ensures EXPLICIT IDENTIFICATION of the

ACTIVITIES & INTERVENTIONS

• Measure of Change, Process and Time stated explicitly & objectively

• Realistic for children include FUN, ENJOY, REWARD , APPRECIATION

Ratna D Soebadi PIR Perdosri Jatim 2021 25