title: Goal attainment scaling: a direct comparison of alternative rating methods.
abstract: OBJECTIVE
  To compare two alternative rating systems for goal attainment scaling (GAS) intended to improve capture of goal underachievement.
  
  
  METHODS
  A tertiary inpatient neurorehabilitation unit.
  
  
  METHODS
  Secondary comparative analysis of prospective cohort data.
  
  
  METHODS
  A total of 243 patients were included, with 977 goals between them; M:F ratio 146:97, mean age 44.8 (SD 14.2) years.
  
  
  METHODS
  200 (82%) acquired brain injury, 21 (9%) spinal cord injury, 22 (9%) other neurological conditions.
  
  
  METHODS
  Goal attainment scaling-rated achievement of 1-6 patient-selected goals was collected using the standard 5-point scale (-2 to +2) and formula to derive aggregated T-scores, as recommended by its originators. Two alternative 6-point rating systems were applied retrospectively. Version 1 set all baseline scores at '-2' and added '-3' to denote 'worsening'. Version 2 added a '-0.5' score to denote 'partial achievement' for goals starting at '-1', without change to range or baseline scores.
  
  
  RESULTS
  Baseline scores were identical for standard rating and version 2 (median 34.9, interquartile range (IQR) 31.9-35.5), but lower for version 1 (median 21.0, IQR 19.8-22.6), which was reflected in the change scores. While median achieved T-scores were 50.0 for all three methods, version 2 marginally overestimated goal attainment (Wilcoxon z -6.8, P < 0.001), while version 1 underestimated it (Wilcoxon z -7.2, P < 0.001), in comparison with standard goal rating.
  
  
  CONCLUSIONS
  Different goal rating methods may have significant impact on goal attainment scaling results. Version 2 provided the closest match to standard rating, supporting documentation of partial goal achievement without affecting score range. For analysis and reporting, '0.5' scores should be converted to '-1', to maintain parity with standard rating systems.
authors.affiliation: King's College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK. Lynne.turner-stokes@dial.pipex.com
authors.forename: Lynne
authors.initials: L
authors.lastname: Turner-Stokes
authors.forename: Heather
authors.initials: H
authors.lastname: Williams
mesh_terms: D000124:Achievement; D000328:Adult; D001930:Brain Injuries / Q000523:psychology / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000523:psychology / Q000534:rehabilitation; D010358:Patient Participation; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000523:psychology / Q000534:rehabilitation*; D020521:Stroke / Q000523:psychology; D000071939:Stroke Rehabilitation