Goal Attainment Scaling as an Outcome Measure for Randomised Controlled Trials: A Systematic Scoping Review

BACKGROUND: Goal Attainment Scaling (GAS) is an individualised outcome measure which can be used in research settings to assess achievement of participant-important priorities and goals. METHODS: A systematic scoping review was completed with the objective of: (1) Identifying the healthcare settings in which GAS has been used as an outcome measure. (2) Describing how GAS has been implemented by researchers in those trials. PubMed, CENTRAL, EMBASE and PsycINFO were searched without limits from their inceptions to 1 September 2021 for randomised controlled trials conducted in healthcare settings where GAS was used as an outcome measure for adults. Two reviewers independently completed both the screening and data extraction, with a third adjudicating conflicts. RESULTS: Of 1,764 articles screened, 37 studies were included. Most trials (86%) were solely undertaken in outpatient settings. They were frequently conducted within the disciplines of rehabilitation (57%), geriatric medicine (24%) and neurology (11%). Sample sizes ranged from 8 to 468, with a mean of 84 participants. GAS was a primary outcome measure in 38% of studies. There were inconsistencies between trials in the use of scales and the calculation of GAS scores. Implementation aspects such as the personnel involved, the training provided, and calibration and review mechanisms, were heterogeneously and scarcely reported. CONCLUSIONS: GAS has been used as an outcome measure across a wide range of disciplines and trial settings. However, there are inconsistencies in how it has been applied and implemented. Developing a cross-disciplinary practical guide to support a degree of standardisation in its implementation may be beneficial in increasing the reliability and comparability of trial results.

The Association Between Sarcopenia and Functional Improvement in Older and Younger Patients Who Completed Inpatient Rehabilitation: A Prospective Cohort Study

Objective: To investigate the association between sarcopenia and functional improvement in patients older and younger than 65 years upon completion of an inpatient rehabilitation program.Design: Prospective cohort study.Participants: Adult consecutive patients who completed the inpatient rehabilitation program at a metropolitan tertiary referral hospital general inpatient rehabilitation unit.Methods: Sarcopenia status was determined using the European Working Group on Sarcopenia in Older People 2 algorithm, using muscle mass measured by BioImpedance Analysis and grip strength. Progress in rehabilitation was measured using change in the Functional Independence Measure and Goal Attainment Scaling score. To investigate the age group by sarcopenia status interaction we used quantile regression models with bootstrapped standard error estimation for functional improvement and linear regression model with robust standard error estimation for GAS score.Results: 257 participants [128 (50%) male, median age 63 years (IQR: 52–72)], 33(13%) with sarcopenia, completed inpatient rehabilitation [median length of stay 16 days (IQR: 11–27.5)]. Participants' median Functional Independence Measure change was 24 (IQR 15–33.5) and mean total Goal Attainment Scaling score was 57.6 (SD 10.2). Adjusting for admission Functional Independence Measure score, the median difference in Functional Independence Measure change between participants with and without sarcopenia was: −4.3 (95% CI: −10.6, 1.9); p = 0.17 in participants 65 years and younger, and 4.6 (95% CI: 1.0, 8.2); p = 0.01 in participants older than 65; age-by-sarcopenia interaction p = 0.02.Conclusions: Unlike younger people, older people with sarcopenia have greater functional improvement in inpatient rehabilitation than those without sarcopenia.

Determining the effect of tele-rehabilitation on patients with stutter using the goal attainment scaling (GAS)

Background Lack of proper and timely patients' access to speech pathologists can affect the treatment and follow-up process; therefore, patients do not achieve the expected therapeutic goals. The aim of this study was to determine the effect of tele-rehabilitation on the stuttering patients using the goal attainment scaling (GAS). Methods This interventional study was carried out on patients who visited the rehabilitation centers affiliated to the Jahrom Welfare Office. They underwent remote speech therapy using Skype. To evaluate the treatment outcomes of the stuttering patients, GAS was used. Results The participants' speech and lingual skills improved using videoconferencing. The mean score of total GAS for patients was 53.08. Of 112 health goals, patients reached the expected or higher than expected levels in 78 goals. Conclusions Rehabilitation through video conferencing was effective for patients with stuttering, improved their speech, and decreased their stuttering. Since, application of remote rehabilitation services can provide regular access to healthcare services, it can lead to improving patient treatment provide more frequent and faster treatment follow-up.

Nomothetic EORTC IN-PATSAT 32 and idiographic GAS questionnaires in the assessment of surgical treatment in patients with endometrial cancer

Introduction: Identification and attainment of the goals of cancer patients is an important aspect of personalized treatment. Aim of the study: The study aimed to assess the following aspects in patients treated surgically for endometrial cancer: 1) level of satisfaction with hospitalization using the EORTC IN-PATSAT32 nomothetic questionnaire; 2) degree of goals attainment using the Goal Attainment Scaling (GAS) idiographic questionnaire; 3) correlation between these evaluation methods. Material and method: The study included 123 patients with endometrial cancer (FIGO I–II) treated surgically at the Department of Obstetrics and Gynecology in Rzeszów in 2012–2014. EORTC IN-PATSAT32 and GAS questionnaires were used. The collected material was analyzed using the Statistica 10.0 software. Results: The overall level of satisfaction measured with the IN-PATSAT32 scale was 72.2 ± 20.5. The technical skills were rated the highest in nurses (74.5 ± 17.6) and doctors (69.3 ± 17.8), while the lowest score was awarded for hospital assess (54.7 ± 23.3). The overall satisfaction with care was 72.2 ± 20.5. In the personalized GAS scale, the patients listed individual expectations before the surgery, assigning ranks to their importance. For most of them, it was a very high (A) or high (B) rank. The patients assigned the highest ranks to quick mobilization, success of the operation, and willingness to be healthy. The average value of the level of goal attainment on the discharge date was 63.7 ± 9.4 points. Statistically significant correlations between the questionnaires were found for the level of goal attainment and the assessment of various aspects of hospital care. Conclusions: The study proved that the EORTC IN-PATSAT32 questionnaire was correlated with GAS questionnaire, and additionally provided knowledge about individual goals of care and the degree of their attainment. The use of nomothetic and idiographic tools gives wider possibilities in the planning and implementation of personalized care.

Feasibility of Goal Attainment Scaling in Chronic Low Back Pain: Protocol for Training & Implementation in an Outpatient Physical Therapy Setting (Preprint)

BACKGROUND Patient engagement in decisions regarding their healthcare may lead to improved outcomes and improved adherence to treatment plans. While there are several options for involving patients in their healthcare, goal setting is a readily accessible method for physical therapists to increase the involvement of patients in healthcare decisions. Physical therapy goals are often provider-generated and based on subjective information or standardized fixed-item patient-reported outcome measures. However, these outcome measures may provide a limited scope of activity and participation limitations which may not capture the needs of individual patients. Goal Attainment Scaling (GAS) is a patient-centered approach to involving patients in setting meaningful goals. While GAS has been shown to be reliable, valid, and sensitive to change in various population, there is limited evidence in the United States about utilizing GAS in the physical therapist management of patients with low back pain (LBP). OBJECTIVE The purpose of this report is to describe the protocol for a study to a) develop an application of GAS procedures to be used by physical therapists treating patients with chronic LBP in the United States and b) to test the feasibility of applying GAS procedures in chronic LBP in an outpatient physical therapy setting. METHODS This study will use a mixed-methods design with two (2) phases (Phase 1: Qualitative, Phase 2: Quantitative). The qualitative phase of the study will employ focus groups of patients with chronic LBP to identify an inventory of goals that are important and measurable. This inventory will be used to develop a series of leading questions that will allow physical therapists to assist patients in establishing goals in the clinical setting. The quantitative phase of the study will pilot-test the inventory developed in the qualitative arm in patients with chronic LBP to determine feasibility, reliability, validity, and responsiveness. We will also compare how well GAS captures change over time as compared to traditional fixed-item patient-reported measures. RESULTS We anticipate that this study will demonstrate that GAS can be implemented successfully by outpatient physical therapists, and it will demonstrate clinically important changes that are important to patients with chronic LBP. CONCLUSIONS GAS represents an opportunity for patient-centered care in the physical therapy management of chronic LBP. While GAS is not new, it has never been studied in a real-world clinical setting for the physical therapy management of chronic LBP which have unique time and productivity constraints. For GAS to be successfully implemented in this environment, we must demonstrate that clinicians can be trained efficiently and reliably, that GAS can be implemented in the clinical setting in under 15 minutes, and that GAS is able to detect clinically meaningful change in patient outcomes. CLINICALTRIAL N/A