Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis

Abstract

Objectives: To use goal attainment scaling (GAS) to measure clinically important functional change in persons with multiple sclerosis (MS) and to assess its responsiveness compared with standard measures used to evaluate progress in rehabilitation.

Design: Prospective, observational cohort study.

Setting: Tertiary inpatient rehabilitation unit in Victoria, Australia.

Participants: Consecutive sample of 24 persons with MS admitted for comprehensive rehabilitation program. The male-to-female ratio was 10:14, and the mean age +/- standard deviation was 52.0+/-8.3 years (range, 37-62y). Over half (n=14 [58.3%]) had secondary progressive MS.

Interventions: Not applicable.

Main outcome measures: GAS scores were calculated for 5 to 10 priority goals set prospectively by each patient in agreement with the multidisciplinary treating team and compared with standard outcome measures-the FIM instrument and Barthel Index-rated on admission and discharge from the program. Patients were categorized into responders and nonresponders based on an overall clinical global impression.

Results: Of 203 selected goals, 167 were achieved at the predicted level. GAS recorded outcomes for 105 individualized goals not measured by the FIM and Barthel Index. Although all 3 measures showed statistically significant change from admission to discharge (P<.001), only GAS scores strongly correlated with the Clinical Global Impression scale (rho=-.86, P<.001). GAS discharge scores differed significantly between the responder and nonresponder groups (Mann-Whitney, z=-3.78, P<.001). Different measures of effect size gave different results, but GAS was consistently more responsive than either the FIM or Barthel Index.

Conclusions: This preliminary study suggests that GAS is a responsive and useful outcome measure for the rehabilitation of persons with MS, providing added value to standardized outcome measurement.