Responsiveness of goal attainment scaling in a randomized controlled trial of comprehensive geriatric assessment.
OBJECTIVE
Frail elderly patients have complex problems that require a multidimensional assessment and a range of treatment goals. Goal Attainment Scaling (GAS) measures multiple, individualized goals, but its responsiveness in comparative clinical trials has not been established.


METHODS
We assessed the responsiveness of GAS in a randomized, controlled trial of an interdisciplinary Mobile Geriatric Assessment Team (MGAT) in 265 rural frail older adults. Sensitivity to change was compared with standard measures; clinical meaningfulness was assessed in relation to a patient and a blinded physician global measure.


RESULTS
At 3 months follow-up, GAS was the most responsive measure (standardized response mean 1.22, Norman's responsiveness statistic 0.58) compared with the Barthel Index (1.13, 0.46), Physical Self-Maintenance Scale (0.10, 0.16, 0.02), Instrumental Activities of Daily Living (0.23, 0.00), and modified Spitzer Quality of Life Index (-0.04, 0.00).


CONCLUSIONS
Only GAS detected clinically important change associated with the MGAT intervention in these frail elderly patients. Clinometric measures can offer a responsive means of evaluating complex interventions.
Rockwood
Kenneth
K
Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. rockwood@is.dal.ca
Howlett
Susan
S
Stadnyk
Karen
K
Carver
Daniel
D
Powell
Colin
C
Stolee
Paul
P
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005194:Family Practice; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006040:Goals; D006801:Humans; D007407:Interviews as Topic; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D012680:Sensitivity and Specificity; D016896:Treatment Outcome