How to agree on a physical therapy goal with your patient

The exercise goal and the patient's goal

Consider this hypothetical appointment.

A patient says they want less knee pain. The physical therapist writes down a goal about completing the home exercise program independently.

Both statements may matter. They do not yet describe the same aim.

Later, the patient explains that they want to walk their dog again. Their partner has taken over the morning walk. The patient misses that part of the day.

The therapist has recorded a task. The patient has described something they want treatment to help them return to.

The problem is not that the therapist chose the wrong exercise. We do not have enough information to judge that. The missing step is checking the connection together.

A useful next question might be: "What would you like to be different about that walk?"

That question does not promise recovery. It helps the therapist understand what the patient means.

Ask before turning a wish into a target

"Less pain" does not need correcting into a more impressive answer. Pain relief may be the person's main priority.

Our recommendation is to ask what that change would mean to them. Do not assume the answer must be an activity.

For example:

• "What would you most like treatment to help with?"
• "What matters about that to you?"
• "Of the things you mentioned, which should we discuss first?"

These are suggested words, not a tested script.

The National Institute for Health and Care Excellence's shared decision-making guidance supports asking what matters to the person. It also recommends asking what they hope to gain and jointly setting priorities for the discussion.

The guidance was published in June 2021 for healthcare in the United Kingdom. It provides a communication framework, not United States billing requirements.

"Shared decision making" means that the clinician and patient make decisions together. It does not mean asking patients to choose an exercise dose without clinical advice.

Explain your proposal without calling it agreement

Once the priority is clear, explain what you propose and why. Keep the patient's aim visible during that explanation.

The same guidance recommends discussing how options align with the person's priorities and wider goals. See recommendations 1.2.7 and 1.2.10.

For the hypothetical dog-walking conversation, that might sound like:

"You want the morning walk back. Let's discuss what we need to assess before agreeing on a plan."

That is different from saying, "Do these exercises and you will walk the dog again."

The first statement opens a discussion. The second promises a result that this conversation cannot establish.

If the patient does not see the connection, ask what feels missing. Their concern might change the discussion. It does not automatically settle the clinical decision.

Keep exercise choice, progression and safety within the treating clinician's assessment. This article does not recommend any particular treatment.

Record the difference between proposed and agreed

We suggest a short goal-agreement record. Its purpose is to stop an unfinished discussion from looking settled.

Here is the hypothetical appointment written two ways:

This is an editorial conversation aid. It is not a validated scale, a completed clinical goal, or a billing documentation template.

The right-hand column deliberately leaves a gap. Agreeing to discuss a goal is not the same as agreeing on the goal itself.

Do not fill that gap with a distance, deadline or recovery promise that nobody agreed.

The guidance's recording recommendation, 1.2.17, supports documenting the decision and what mattered to the person. Our proposed fields and example are HepBuddy's interpretation, not a form prescribed by that guidance.

When the patient and therapist want different things

Suppose the therapist wants to discuss the home program. The patient wants to discuss whether treatment addresses their main concern.

Do not record agreement because the patient nodded through the explanation.

Try naming the difference:

"I started with the exercise plan. You want to know whether we are working toward the change that matters to you."

Then agree on the next discussion or decision. If a goal remains unresolved, record that plainly.

Recommendations 1.2.14 through 1.2.16 address agreeing a joint plan, making next steps clear and arranging review. They do not require this particular script.

This approach also has limits. It does not resolve disagreements about clinical safety, establish whether treatment is appropriate, or replace a fuller assessment.

Check understanding after checking the purpose

Once a plan is agreed, teach-back for home exercises can help you check the explanation. Ask the patient to explain or show the plan in their own way.

Then discuss where the agreed home program fits into their week.

These conversations answer different questions:

• Goal agreement: What are we working toward?
• Teach-back: Have I explained the plan clearly?
• Weekly planning: Where could this agreed plan fit?

A patient can understand the instructions while still questioning their purpose.

Keep the follow-up record equally clear. Exercise adherence, meaning how closely exercise follows the agreed plan, is not the same as achieving a functional goal.

Neither this worksheet nor the cited guidance establishes that this script improves home exercise adherence, pain or recovery.

HepBuddy's recommendation is narrower: make the patient's priority and the actual agreement visible. Leave clinical targets to the treating clinician and patient.