Document Detail

Goal attainment scaling: a direct comparison of alternative rating methods.
MedLine Citation:
PMID:  20026573     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To compare two alternative rating systems for goal attainment scaling (GAS) intended to improve capture of goal underachievement.
SETTING: A tertiary inpatient neurorehabilitation unit.
DESIGN: Secondary comparative analysis of prospective cohort data.
PARTICIPANTS: A total of 243 patients were included, with 977 goals between them; M:F ratio 146:97, mean age 44.8 (SD 14.2) years.
DIAGNOSIS: 200 (82%) acquired brain injury, 21 (9%) spinal cord injury, 22 (9%) other neurological conditions.
METHODS: Goal attainment scaling-rated achievement of 1-6 patient-selected goals was collected using the standard 5-point scale (-2 to +2) and formula to derive aggregated T-scores, as recommended by its originators. Two alternative 6-point rating systems were applied retrospectively. Version 1 set all baseline scores at '-2' and added '-3' to denote 'worsening'. Version 2 added a '-0.5' score to denote 'partial achievement' for goals starting at '-1', without change to range or baseline scores.
RESULTS: Baseline scores were identical for standard rating and version 2 (median 34.9, interquartile range (IQR) 31.9-35.5), but lower for version 1 (median 21.0, IQR 19.8-22.6), which was reflected in the change scores. While median achieved T-scores were 50.0 for all three methods, version 2 marginally overestimated goal attainment (Wilcoxon z -6.8, P < 0.001), while version 1 underestimated it (Wilcoxon z -7.2, P < 0.001), in comparison with standard goal rating.
CONCLUSION: Different goal rating methods may have significant impact on goal attainment scaling results. Version 2 provided the closest match to standard rating, supporting documentation of partial goal achievement without affecting score range. For analysis and reporting, '0.5' scores should be converted to '-1', to maintain parity with standard rating systems.
Lynne Turner-Stokes; Heather Williams
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-12-21
Journal Detail:
Title:  Clinical rehabilitation     Volume:  24     ISSN:  1477-0873     ISO Abbreviation:  Clin Rehabil     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-07     Completed Date:  2010-04-20     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  8802181     Medline TA:  Clin Rehabil     Country:  England    
Other Details:
Languages:  eng     Pagination:  66-73     Citation Subset:  IM    
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MeSH Terms
Brain Injuries / psychology,  rehabilitation*
Cohort Studies
Middle Aged
Nervous System Diseases / psychology,  rehabilitation
Patient Participation
Prospective Studies
Spinal Cord Injuries / psychology,  rehabilitation*
Stroke / psychology,  rehabilitation*
Grant Support
RP-PG-0407-10185//Department of Health

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