Goal setting is a cornerstone of pediatric rehabilitation, directing therapy planning ( Forsingdal et al., 2014), fostering collaboration ( Kalmanson et al., 1992; An et al., 2016), and improving clinical outcomes ( Dekker et al., 2020). For children with neuromotor disabilities, goals must be meaningful and aligned with family priorities ( Dekker et al., 2020; Metzler et al., 2021). The SMART framework (Specific, Measurable, Achievable, Relevant, Time-bound) is widely used to structure rehabilitation goals and improve goal quality and therapy effectiveness ( Bexelius et al., 2018; Nguyen et al., 2021).

Each SMART element adds value: Specific goals provide focus ( Øien et al., 2010); Measurable goals allow progress tracking ( Harpster et al., 2019); Achievability enhances self-efficacy ( Bandura, 1997; Locke and Latham, 2006; Playford et al., 2009); Relevant goals reflect family values; and Time-bound goals provide structure ( Øien et al., 2010). Yet SMART goals may not fully capture developmental priorities or family perspectives ( Wiart et al., 2010).

Collaborative goal setting—where children, caregivers, and clinicians jointly develop goals—is increasingly emphasized in pediatric rehabilitation ( Forsingdal et al., 2014). It acknowledges families as experts and prioritizes their insights ( King et al., 2004). This approach enhances motivation, satisfaction ( Siebes et al., 2007), and participation ( Costa et al., 2017), and supports self-efficacy ( Brewer et al., 2014; Kruijsen-Terpstra et al., 2014; Schwarzer et al., 2011; Wiart et al., 2010; Pritchard-Wiart and Phelan, 2018). Emerging digital tools such as COSMO and Kid’EM apps also facilitate collaborative goal setting and reduce caregiver burden ( Kura et al., 2025; Vannier et al., 2025).

Since 2007, the WHO International Classification of Functioning – Child and Youth (ICF-CY) has provided a biopsychosocial model for understanding impairments, activity limitations, and participation restrictions, incorporating environmental and personal factors ( Lee, 2011) . In 2011, the CanChild Centre adapted this model into the “F-words for Child Development”: Function, Family, Fitness, Fun, Friends, and Future ( Rosenbaum and Gorter, 2012). This framework is strength-based, family-friendly, and closely linked to children’s everyday experiences ( Rosenbaum and Gorter, 2012).

Despite wide recognition, the F-words are underused in practice. Many goals remain capacity- or body-function focused rather than participation-oriented ( Nijhuis et al., 2008a). Research highlights a mismatch between therapist-documented and caregiver-perceived goals, with caregivers concerns often underrepresented ( Nijhuis et al., 2008b; Angeli et al., 2019).

Several goal-setting tools support family involvement. The Canadian Occupational Performance Measure (COPM) identifies priorities and tracks progress, and Goal Attainment Scaling (GAS) measures individual outcomes. However, COPM is subjective and less suited for young children ( Ohno et al., 2021), and GAS is time-intensive and complex ( Steenbeek et al., 2008).

There is little published evidence from Arab countries on goal-setting practices in pediatric rehabilitation. It is unclear whether goals set for children with neuromotor disabilities in Qatar are both structured and meaningful for the children and their families.

Study aim: This retrospective study analyzed physical therapy goals set in the largest pediatric outpatient department in Qatar to assess goal quality and alignment with family priorities, using the SMART elements and the F-words framework.

This study examined the pediatric physical therapy goals for children with neuromotor disabilities, integrating the SMART elements with the F-words framework. Out of the total 183 goals analyzed, 97.2% were specific, underscoring the importance of clarity in therapy planning. Specific goals facilitate identification of observable behaviors, support intervention planning, and allow progress tracking, consistent with findings by Bexelius et al. (2018) and King et al. (2004). Goals that were vague, such as “improve posture,” were excluded from SMART compliance, aligning with Bovend’Eerdt et al. (2009) who emphasized that unclear goals hinder monitoring and engagement. Families value specific goals as they enhance understanding and accountability. However variability exists across disciplines, with some therapists being less likely to draft clear objectives ( Graham et al., 2020). Recent literature describe digital tools, such as the Kid’EM-app, which support goal specificity ( Vannier et al., 2025).

Measurability was achieved in 97.2% of goals, reflecting robust use of structured and quantifiable criteria including duration, frequency, assistance level, and success rate. These metrics are essential for tracking progress, guiding interventions, and supporting collaboration among therapists, families, and educators ( Faccioli et al., 2023). Assistance and independence were emphasised in this study, consistent withfindings of Angeli et al. (2019) and Darrah et al. (2012). Performance consistency, efficiency, and endurance were also incorporated, demonstrating a broader and more nuanced application of measurable elements than in a previous study ( Bovend’Eerdt et al., 2009).

Achievability was also met in 97.2% of goals, reflecting careful alignment with each child’s developmental level and severity, especially given that 64.1% had severe neuromotor disabilities. Realistic goal-setting sustains caregiver engagement, reduces burnout, and enhances motor outcomes ( Gray et al., 2012). Therapists consider diagnosis, severity, potential for improvement, comorbidities, and family support when drafting achievable goals ( Bexelius et al., 2018; Poulsen et al., 2015). Limiting the number of concurrent goals helps to focus on achievable improvement ( Sršen, 2023).

Only 53% of goals met the ‘relevant’ criterion criterion, indicating that parent engagement was suboptimal. Among these, families took most of the responsibility in only 12.4% of the goals, while the remaining 87.6% reflected equally shared responsibility between each family and the child’s therapist. The lack of parental engagement in goal setting identified in this study, which is presumed to explain why many goals were not considered relevant, may be attributed to provider beliefs, limited skills, patient capacity and opportunity issues, as well as organizational factors such as the absence of guidelines and insufficient time ( Crawford et al., 2022). Shared, family-driven goal-setting has been associated with more functional, motivating, and ecologically valid outcomes ( King et al., 2004; Kelly et al., 2019). The limited presence of fully independent, family-led goals may reflect underlying cultural perspectives in which families regard therapists as the primary experts on their child’s care ( Crom et al., 2020). At the same time, evidence suggests that parents desire greater involvement in decision-making and goal-setting, underscoring the need for approaches that balance professional expertise with family empowerment ( Terwiel et al., 2017).

The maximum number of goals (98.9%) were time-bound, typically spanning 1–3 months. Time-bound goals sustain motivation, allow regular review, and facilitate caregiver engagement, though timelines must remain flexible to accommodate complex, nonlinear progress in children with neuromotor disabilities like cerebral palsy ( Bexelius et al., 2018; Novak & Cusick, 2006).

Function-related goals dominated, comprising 85.8% of all therapy goals, reflecting a clinical emphasis on mobility, self-care, and daily living skills. This aligns with CanChild’s framework, emphasizing activity and participation over impairments ( Rosenbaum & Gorter, 2012), and is consistent with international evidence that emphasizes functional priorities for children with cerebral palsy ( Jackman et al., 2022; Novak et al., 2020; Brandão et al., 2014).

Only 30.1% of goals were mapped to the Family domain, indicating limited integration of caregiver-centered objectives. In our study, family goals were primarily embedded within home programs, consistent with evidence that family-centered coaching empowers parents by integrating therapy into daily routines and strengthening caregiver capacity ( Novak & Berry, 2014; Morgan et al., 2016). As identified in many studies, parents’ own needs—such as mental health, skill development, and social support—remain underrepresented ( King, 2009; Cunningham & Rosenbaum, 2014). Several study from the Arab region recommends a need for culturally sensitive approaches to optimize family engagement and well-being ( Raman et al., 2010; Al-Kuwari, 2007; Alsaman & Abd El-Naiem, 2021).

Goals related to Fun (24.0%) and Friends (11.5%) were underrepresented, highlighting the limited emphasis on play, enjoyment, and peer relationships, consistent with findings in children with cerebral palsy in Australia ( Imms et al., 2008). Our findings corroborate the work of Kruijsen-Terpstra et al. (2014), who similarly reported that parents of children receiving physical and occupational therapy experienced comparable challenges in communication and collaboration with professionals ( Knox, 2008; Chiarello, 2017; Starling, 2011; Graham et al., 2019). Children with complex disabilities tend to participate less than their typically developing peers, with activities often limited to home-based settings and a narrow range of experiences (Law et al., 2009). This restricted participation underscores the critical need to promote recreational opportunities, as the literature consistently highlights their role in fostering emotional well-being, social inclusion, and autonomy ( Knox, 2008; Chiarello, 2017; Starling, 2011; Howard, 2017; Graham et al., 2019). Limited goals in the domains of Fun, Friends, and Future—essential for holistic development—may indicate an overemphasis on functional and medical outcomes, as noted in previous studies ( Soper et al., 2020; Chiarello et al., 2014; Perrin, Lewkowicz, & Young, 2000).

Limited fitness goals (15.3%) highlight a need for greater integration of health promotion in pediatric physical therapy practice ( Verschuren et al., 2016). Future-oriented goals (8.2%) were the least represented, despite their importance for long-term independence, community integration, and psychosocial resilience ( Schiariti et al., 2014; Palisano et al., 2010; Gona et al., 2011). Spiritual beliefs and hope ( Illum et al., 2018) does play a role in shaping family priorities in future planning, particularly in Muslim communities ( Kermanshahi et al., 2008; Mohamed Madi et al., 2019; Othman et al., 2022).

Combining SMART elements with the F-words framework provides a structured, family-centered approach to goal-settingin pediatric rehabilitation. The goals aligned with the SMART elements provides a structured goal setting format, while utilizing the F-words framework for goal formulation adds meaning for the child and families due to its emphasis on strength-based, participatory care ( Rosenbaum & Gorter, 2012). This combined model (SMART and F-words) in goal setting may be valuable for children with cerebral palsy and those with similar gross motor dysfunction, ensuring that goals are well structured, and also equally meaningful, for the child and family ( Pritchard-Wiart & Phelan, 2018).

Despite strong adherence to SMART elements noted in the goals analyzed, gaps remain in the holistic goal representation of areas meaningful for the children and their families. Limited family engagement in goal setting may have a strong contribution to the underrepresentation of goals within these meaningful areas. However its certainty cannot be established due to the retrospective nature of the study design.

This study highlights both the strengths and gaps in goal setting for children with neuromotor disabilities carried out by pediatric physical therapists in Qatar. Overall, adherence to SMART elements was strong, with notable alignment to specific, measurable, achievable, and time-bound goals. In contrast, the number of goals meeting the relevant element was limited, which may reflect suboptimal family engagement in the goal-setting process. All goals were aligned with at least one F-words domain, with Function predominating. The other domains—Family, Fun, Fitness, Friends, and Future—were comparatively underrepresented, indicating potential gaps in creating family-centered goals and fostering meaningful participation in the child’s environment. To advance family-centered, participation-focused goals, greater family engagement in goal setting is required, alongside enhancing therapist skills in facilitating parent engagement in the goal-setting process. Future prospective studies examining the utility of the F-SMART goal-setting framework are warranted to validate its proposed benefits.

Written informed consent for participation in the study was obtained from the parents of all children involved in this research.