Evaluation of rehabilitation services: the use of goal attainment scaling

Abstract

Goal attainment scaling (GAS) is a procedure for evaluating the effectiveness of intervention in human service programmes. The theory and procedure of GAS are described, and its strict requirements are discussed. An example application of GAS in a rehabilitation centre for physically disabled children is reported. Problems with the application of GAS as an evaluation procedure are discussed, and suggestions are made for dealing with these problems.

Clinimetric properties of participation measures for 5‐ to 13‐year‐old children with cerebral palsy: a systematic review

“…56 Score biased by assessment and expected outcomes; 28 underestimation at baseline or level of expected improvement. 53,54,57,58 Floor effect, unable to record deterioration, 28 no procedure to assign weights; 44 difficulties weighting goals 31,32 *See Table II reported. The SFA presented with a significant burden for users, with an initial assessment time of 1 1 ⁄ 2 to 2 hours.…”

“…22 Moderate concurrence of problems Compared with gross and fine identified on COPM vs motor function and disability 49 spontaneously 50 Significantly correlated to SPSQ, RNLI, and PPL 50 Significant correlation between performance score and physical domain SIP 51 GAS 43 10 paediatric therapists rated goals Low correlation between for infants: supported validity, did not Peabody Gross Motor Scales and differ significantly between therapists 53 GAS T-scores 53,58,59 Supported when goals are appropriate, 12 studies correlate GAS with reasonable, relevant, and complete 28 consumer satisfaction. Significance Reliant on clinical skills of goal low to moderate positive correlationssetters; 28,31,53,54,55 non significant correlations 28 Goals for children with CP supported by expert panel of experienced PTs. 56 Score biased by assessment and expected outcomes; 28 underestimation at baseline or level of expected improvement.…”

“…Issues of validity and reliability for the GAS have been reported widely with concerns raised regarding the appropriateness of goals set, potential bias in both the goal setting and evaluation process, subjectivity of weighting goals, and the generation of the T-score. [30][31][32] Nevertheless, the GAS and the COPM were the only two measures reviewed that had demonstrated ability to capture clinically important change and had been used as outcome measures. 55,[57][58][59][60][61] The two studies reporting responsiveness of the SFA yielded conflicting evidence.…”

Goal attainment scaling in paediatric rehabilitation: a critical review of the literature

“…One of the most remarkable outcomes of our literature search was that the reliability of GAS is largely unknown. Twenty-four years after the introduction of GAS in rehabilitation by Clark and Caudrey, 24 very little is known about the reliability of the scale content and scoring of predetermined scales. Despite this serious lack of knowledge, GAS has been used extensively in recent outcome measurements among children with CP to derive assumptions about the functional benefits of certain interventions.…”

Integrating stakeholder perspectives in outcome measurement

“…Methods such as goal attainment scoring (Clark & Caudrey, 1983), assessment of patient-reported outcomes (Cella et al, 2007b) and subjective appraisals (Brown et al, 2004) are efforts to privilege the lived experiences and personal priorities of patients and rehabilitation clients. In 2007, the US Food and Drug Administration issued guidelines for patient-reported outcomes, demanding that potential end-users be involved in the development of outcome measures used in clinical drug trials, not just at the level of item development and review but also in developing the conceptual framework upon which outcome measures are based (US Department of Health and Human Services et al, 2006).…”