Goal attainment scaling as an outcome measure for randomised controlled trials: a scoping review

Logan, Benignus; Jegatheesan, Dev; Viecelli, Andrea K.; Pascoe, Elaine M.; Hubbard, Ruth E.

doi:10.1136/bmjopen-2022-063061

Cited by 11 publications

(14 citation statements)

References 68 publications

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“…The primary outcome was self-reported personal recovery goals at 15-weeks post randomization, measured in a structured way with the GAS weighted T -score; 33–35 following a recent review. 36 GAS is sensitive to change, has been the primary outcome for both pharmacological and psychological interventions in psychiatric disorders, and measures cognitive rehabilitation outcomes 37 including CR. 38 A baseline participant interview to establish up to 3 goals weighted on importance and difficulty following the scoring manual.…”

Section: Methodsmentioning

confidence: 99%

Cognitive Remediation Works But How Should We Provide It? An Adaptive Randomized Controlled Trial of Delivery Methods Using a Patient Nominated Recovery Outcome in First-Episode Participants

Wykes

Stringer

Boadu

et al. 2023

Schizophrenia Bulletin

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Background and Hypothesis Cognitive remediation (CR) benefits cognition and functioning in psychosis but we do not know the optimal level of therapist contact, so we evaluated the potential benefits of different CR modes. Study Design A multi-arm, multi-center, single-blinded, adaptive trial of therapist-supported CR. Participants from 11 NHS early intervention psychosis services were independently randomized to Independent, Group, One-to-One, or Treatment-as-usual (TAU). The primary outcome was functional recovery (Goal Attainment Scale [GAS]) at 15-weeks post randomization. Independent and TAU arms were closed after an interim analysis, and three informative contrasts tested (Group vs One-to-One, Independent vs TAU, Group + One-to-One vs TAU). Health economic analyses considered the cost per Quality Adjusted Life Year (QALY). All analyses used intention-to-treat principles. Study Results We analyzed 377 participants (65 Independent, 134 Group, 112 One-to-One, 66 TAU). GAS did not differ for Group vs One-to-One: Cohen’s d: 0.07, −0.25 to 0.40 95% CI, P = .655; Independent vs TAU: Cohen’s d: 0.07, −0.41 to 0.55 95% CI, P = .777. GAS and the cognitive score improved for Group + One-to-One vs TAU favoring CR (GAS: Cohen’s d: 0.57, 0.19–0.96 95% CI, P = .003; Cognitive score: Cohens d: 0.28, 0.07–0.48 95% CI, P = .008). The QALY costs were £4306 for Group vs TAU and £3170 for One-to-One vs TAU. Adverse events did not differ between treatment methods and no serious adverse events were related to treatment. Conclusions Both active therapist methods provided cost-effective treatment benefiting functional recovery in early psychosis and should be adopted within services. Some individuals benefited more than others so needs further investigation. Trial registration ISRCTN14678860 https://doi.org/10.1186/ISRCTN14678860 Now closed.

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Section: Methodsmentioning

confidence: 99%

Cognitive Remediation Works But How Should We Provide It? An Adaptive Randomized Controlled Trial of Delivery Methods Using a Patient Nominated Recovery Outcome in First-Episode Participants

Wykes

Stringer

Boadu

et al. 2023

Schizophrenia Bulletin

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“…The Goal Attainment Scaling (GAS), developed by Kiresuk,47 is used to assess participants’ progress in achieving their personal goals during an intervention. This method uses a 5-point Likert scoring system with −2 to –1, 0, 1 and 2 as the scoring standards 48. Prior to the intervention survey, participants will be asked to select 3–5 goals from the indicator pool, and each goal is scored at baseline and expected levels.…”

Section: Methodsmentioning

confidence: 99%

Effects of a physical activity promotion programme on body composition in emerging adults with physical inactivity: a study protocol of a randomised controlled trial

Xu,

Tao,

Chen

et al. 2023

BMJ Open

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IntroductionA dramatic decline in physical activity may occur in emerging adulthood because of a major transition over the course of a life. The potential for implementing structured behaviour modification strategies to enhance risk-reducing clinical outcomes is widely recognised. The active participation of clients in the discussion and care process is crucial for optimising intervention outcomes and enhancing individuals’ motivation to adopt and maintain healthy behaviours. This study therefore aims to evaluate the effectiveness of a physical activity promotion programme based on the goal attainment theory in relation to emerging adults’ body composition, using a face-to-face and e-health blended interventions.Methods and analysisA two-arm, double-blind, randomised, controlled study will be conducted in 114 university students aged 18–25 years with physical inactivity. The intervention assignment will be blind to study participants, outcome assessors and study statisticians. A goal achievement theory-based physical activity promotion programme is developed in this study, which is a 16-week, face-to-face and e-health-blended physical activity promotion intervention. After informed consent, participants will be randomly assigned to either a control group or a treatment group before the start of the study. The primary outcome is body composition (ie, skeletal muscle mass, body fat mass, body mass index and body fat percentage). Other outcomes include physical activity level, goal attainment scale scores, exercise self-efficacy and motivation level, which will be assessed during the intervention (every 4 weeks) and at the 1 month follow-up. Continuous variables have means and SD, while categorical variables have frequencies and percentages. Independent-samples t-tests will be used to compare continuous variable changes. χ2tests will be used to compare categorical variable changes. Based on the baseline scores, analysis of covariance will compare the follow-up results.Ethics and disseminationThis study was approved by the Ethics Committee of Hangzhou Normal University (ratification date: 14 November 2022, 2022059). The results of the study will be submitted for publication and dissemination in a peer-reviewed journal.Trial registration numberNCT05697679.

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“…Given GAS is the primary outcome measure and concerns exist regarding implementation due to the risk of poorly written goals and scales [ 40 – 42 ], a comprehensive training package was developed. This training was designed to ensure the consistent application of GAS by enabling research nurses and delegates to administer it confidently and competently.…”

Section: Data Collection and Managementmentioning

confidence: 99%

Study protocol for The GOAL Trial: comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient-identified goals—a cluster randomised controlled trial

Logan

Viecelli

Johnson

et al. 2023

Trials

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Background An increasing number of older people are living with chronic kidney disease (CKD). Many have complex healthcare needs and are at risk of deteriorating health and functional status, which can adversely affect their quality of life. Comprehensive geriatric assessment (CGA) is an effective intervention to improve survival and independence of older people, but its clinical utility and cost-effectiveness in frail older people living with CKD is unknown. Methods The GOAL Trial is a pragmatic, multi-centre, open-label, superiority, cluster randomised controlled trial developed by consumers, clinicians, and researchers. It has a two-arm design, CGA compared with standard care, with 1:1 allocation of a total of 16 clusters. Within each cluster, study participants ≥ 65 years of age (or ≥ 55 years if Aboriginal or Torres Strait Islander (First Nations Australians)) with CKD stage 3–5/5D who are frail, measured by a Frailty Index (FI) of > 0.25, are recruited. Participants in intervention clusters receive a CGA by a geriatrician to identify medical, social, and functional needs, optimise medication prescribing, and arrange multidisciplinary referral if required. Those in standard care clusters receive usual care. The primary outcome is attainment of self-identified goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index – Short Form), transfer to residential aged care facilities, cost-effectiveness, and safety (cause-specific hospitalisations, mortality). A process evaluation will be conducted in parallel with the trial including whether the intervention was delivered as intended, any issue or local barriers to intervention delivery, and perceptions of the intervention by participants. The trial has 90% power to detect a clinically meaningful mean difference in GAS of 10 units. Discussion This trial addresses patient-prioritised outcomes. It will be conducted, disseminated and implemented by clinicians and researchers in partnership with consumers. If CGA is found to have clinical and cost-effectiveness for frail older people with CKD, the intervention framework could be embedded into routine clinical practice. The implementation of the trial’s findings will be supported by presentations at conferences and forums with clinicians and consumers at specifically convened workshops, to enable rapid adoption into practice and policy for both nephrology and geriatric disciplines. It has potential to materially advance patient-centred care and improve clinical and patient-reported outcomes (including quality of life) for frail older people living with CKD. Trial registration ClinicalTrials.gov NCT04538157. Registered on 3 September 2020.

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Goal attainment scaling as an outcome measure for randomised controlled trials: a scoping review

Cited by 11 publications

References 68 publications

Cognitive Remediation Works But How Should We Provide It? An Adaptive Randomized Controlled Trial of Delivery Methods Using a Patient Nominated Recovery Outcome in First-Episode Participants

Cognitive Remediation Works But How Should We Provide It? An Adaptive Randomized Controlled Trial of Delivery Methods Using a Patient Nominated Recovery Outcome in First-Episode Participants

Effects of a physical activity promotion programme on body composition in emerging adults with physical inactivity: a study protocol of a randomised controlled trial

Study protocol for The GOAL Trial: comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient-identified goals—a cluster randomised controlled trial

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