Use of Goal Attainment Scaling to Measure Treatment Effects in an Anti-Dementia Drug Trial

Abstract

We report data on the validity and responsiveness (i.e. sensitivity to change) of assessment instruments including Goal Attainment Scaling (GAS), at a single site in a multicentre trial of the experimental therapeutic agent linopirdine. Fifteen people (11 women) were evaluated. GAS yielded a mean 3.7 goals per patient (range 2–6). The mean gain in the GAS scores, 2.7 ± 16.4, was compared to changes in the Alzheimer''s Disease Assessment Scale-Cognitive Section, the Global Deterioration Scale, Clinical Global Impression and the Mini-Mental State Exam. GAS had the largest relative efficiency (0.47) when compared to the standard. GAS also had the largest effect size (0.61). The data suggest that an individualized approach may have merit as an outcome measure and as a means to better understanding treatment effects. Qualitative analysis revealed consistent goal setting in self-care, behaviour, cognition and leisure, suggesting that these areas should routinely be evaluated.

Goal-Setting Method and Goal Attainment Measures in Physical Therapy for Stroke Patients: a Systematic Review

“…Therefore, this may be considered to be an interview via free conversation, to set goals. The validity, reliability, and responsiveness of GAS has been evaluated not only in the mental health field but also in various fields such as those involving children with disabilities (e.g., cerebral palsy and mental and/or physical retardation), elderly patients, brain injury patients, dementia patients, and frail elderly people (Table 3, 4) 8, 11,17,18,[48][49][50][51][52][53][54][55][56][57][58][59][60][61] . In children with disabilities, no significant correlation was noted between the standardized measure, the Peabody Gross Motor Scale, and the GAS T-score 17,18) , which suggests that GAS determines aspects different from the Peabody Gross Motor Scale.…”

“…GAS Tscores are then calculated by assigning weights to each goal. GAS evaluates the validity, reliability, and responsiveness as the goal attainment measures for patients with mental health disorders or brain damage, physically handicapped children, or the elderly 11,[48][49][50][51][52][53][54][55][56][57][58][59][60][61] . Reid et al 21) reported the clinical utility of GAS for stroke patients, but there have been no studies assessing its validity, reliability, and responsiveness.…”

“…Non significant correlations between PGMS and GAS change score (r=0.25, 0.33) 17,18) No correlation between COPM and GAS 49) Brain injuries Content analysis of goal areas (GAS goals were set in 17 of 18 goal areas in the rehabilitation of brain injury patients) supported content validity 52) NS Strong correlation between CGI and GAS change score (r=0.81) 52) Geriatric (include stroke) The agreement (82%) in identifying goal areas by two geriatricians, and content analysis of goal areas (GAS goals were set in 12 of 13 goal areas in the geriatric rehabilitation) supported content validity 54) . Content analysis of goal areas supported content validity (GAS goals were grouped into major categories, of which the most common were mobility, future care, ADL/IADL, bowel and bladder problems) 55) Strong correlation between BI and GAS change score (r=0.86) 54) Moderate correlation between BI, OARS-IADL and GAS change score (r=0.60, 0.48) 55) Alzheimer's disease or dementia NS Strong correlation between CGI (r=0.85), moderate correlation between ADAS-Cog (r=0.52), GDS (r=0.63) and GAS change score 56) Poor correlation between BI, HABAM, CIRS and GAS change score (r s =-0.22 ~ 0.17) 57) C o g n i t i v e rehabilitation NS NS Moderate correlation between MEDLS (r=0.52), RDRS (r=-0.47) and GAS change score 58) Frail elderly NS NS Moderate correlation between BI (r=0.59), FIM (r=0.45), the Physical Self-Maintenance Scale (r=-0.54) and GAS change score 59) Stroke NS NS NS Other NS Pain: Moderate to low correlation between walking (in 5 min) (r=0.47), ODQ (r=0.31) and GAS change score 61) Lower-extremity amputations: Non-significant correlations between BI, LCI, and GAS change score 60) Table 3. Evidence for validity of Goal Attainment Scaling (GAS) Spearman's rank correlation coefficient Note: Content validity was examined by having 10 physical therapists rate(5-point scale) 10 randomly selected GAS-formatted goals on three dimensions: (1)the importance of the goal for motor development and function, (2)whether the expected progress was achievable, and (3)whether each of the four levels of change was clinically important.…”

A UK survey of treatment of dementia in Parkinson's disease

“…Within the context of the treatment of AD, a small body of literature is growing that questions the clinical meaningfulness of conventional outcome measures such as the MMSE and suggests more patient-centred, subjective clinimetric scales should be used instead. 13,14 Such approaches will allow for more flexibility in identifying and monitoring goals and outcomes that are meaningful to patients, carers and clinicians, and need to be validated in PDD.…”

Goal Setting Education and Counseling Practices of Diabetes Educators

“…34 During the initial three month diet therapy, each participant had monthly visits with a diabetes educator; most often with a dietitian and a doctor. 35 The initial three month diet for all participants was approximately 50% carbohydrate, low in saturated fat, and moderately high in fiber.…”