Goal Attainment Scaling Allows Program Evaluation of a Home-Based Occupational Therapy Program

Abstract

A problem for occupational therapists involved in home-based rehabilitation is the dichotomy between traditional functional status measures, which are commonly reported by therapists to have insufficient flexibility and poor clinical sensitivity, and individualized methods (which do not allow inter-patient comparison for program evaluation). This study used Goal Attainment Scaling (GAS) to evaluate both individual and program change. The study demonstrates that GAS was a simple, clinically meaningful measure of change which evaluated patient-centered outcomes and program effects concurrently. In addition, this measure was applied to a traditionally challenging service, that of a home-based rehabilitation program. Goal Attainment Scaling was demonstrated to be useful as an outcome measure for patients with multiple, complex rehabilitation needs, such as those served by a home-based rehabilitation occupational therapy service. It was able to accurately detect meaningful change (necessary for demonstrating clinically significant improvement at the level of the individual patient), be administered in a time-effective manner, and also allow the clinician to evaluate program effectiveness.

Multiple Stakeholder Perspectives on Teletherapy Delivery of Speech Pathology Services in Rural Schools: A Preliminary, Qualitative Investigation

“… a Based on n = 99 scheduled teletherapy sessions b Based on n = 79 teletherapy sessions conducted as scheduled c Based on data from n = 83 teletherapy sessions, including 4 sessions that were cancelled or cut short due to persistent difficulties d Percentages total >100% as 2 sessions had both a parent and teacher/teacher’s aide present. e Based on data from n = 7 participating children for whom therapy goals were established and for whom final review assessment data was available f A T-score of 50 indicates that goals are, on average, achieved ( Lannin, 2003 ) …”

Dealing with Real-Life Challenges: Outcome of a Home-Based Occupational Therapy Intervention for People with Severe Psychiatric Disability

“…The GAS scores are calculated with a statistical formula that produces an overall score and adjusts an average of the outcome scores for the relative weighting assigned to goals, the varying number of goals, and the expected inter-correlation among the scales. Research has demonstrated that GAS is a sensitive and clinically meaningful measure of change with evidence for the reliability and validity when used to measure outcomes in home-based rehabilitation (Lannin, 2003). Assessment of Motor and Process Skills (AMPS) (Fisher, 2006b) is an observation-based assessment to measure the quality of the participant's performance of daily living activities.…”

Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation–A systematic review

“…Ratings between participants and significant others agreed on 70% of occasions [59]. GAS was more responsive than the FIM and BI (ES 9.0 SRM: 2.4 t value 10.0 z value 1.4) in MS [104] and was responsive to patient centred outcomes and program change in a mixed neurological sample [115].…”

“…Goal Attainment Scaling (GAS) was first introduced by Kirusek and Sherman [176] and provides a structured approach to defining and measuring individualized patient centered and/or program based goals. A total of 9 studies evaluated the psychometric properties, in post-stroke (n = 2) [43,156], MS (n = 1) [104], TBI (n = 3) [59,120,125]and mixed ABI (n = 3) samples [41,115,124]. Only one study met inclusion criteria that specifically identified participants with upper limb spasticity (in a sample greater than 6 months post-stroke) [156].…”