Goal attainment scaling: does it provide added value as a person-centred measure for evaluation of outcome in neurorehabilitation following acquired brain injury?
OBJECTIVE
To compare goal attainment scaling (GAS) and standardized measures in evaluation of person-centred outcomes in neurorehabilitation.


METHODS
A prospective cohort analysis from a tertiary inpatient neuro-rehabilitation service for younger adults with complex neurological disability.


METHODS
Consecutive patients (n = 164) admitted for rehabilitation following acquired brain injury (any cause) over 3 years. Mean age 44.8 (standard deviation 14.4) years.


METHODS
66% strokes, 18% trauma, 16% other. Male:female ratio 102:62.


METHODS
GAS-rated achievement of 1-6 patient-selected goals was compared with the Functional Assessment Measure (UK FIM+FAM), and Barthel Index (BI), rated on admission and discharge. Personal goals were mapped retrospectively to the FIM+FAM and International Classification of Functioning, Disability and Health (ICF).


RESULTS
Median (interquartile range; IQR) GAS T-scores were 50.0 (44.2-51.8) and moderately correlated with changes in FIM+FAM and BI (both rho 0.38 (p < 0.001)). Standardized response means were 2.2, 1.6 and 1.4 for GAS, FIM+FAM and BI, respectively. Of 667 personal goals set, 495 (74%) were fully achieved. Although 413 (62%) goals were reflected by changes in FIM+FAM, over one-third of goals were set in other areas.


CONCLUSIONS
GAS appeared to be more responsive, and captured gains beyond the FIM+FAM, thus providing added value as an adjunct to outcome measurement in patients with complex disability.
Turner-Stokes
Lynne
L
Department of Palliative Care, Kings College London, School of Medicine, Middlesex, UK. lynne.turnerstokes@dial.pipex.com
Williams
Heather
H
Johnson
Jane
J
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D055815:Young Adult