Goal Attainment Scaling in rehabilitation: An educational review providing a comprehensive didactical tool box for implementing Goal Attainment Scaling

Abstract

Context: Goal Attainment Scaling (GAS) is a person-centered and collaborative approach, allowing to assess the effectiveness of an intervention on personally relevant goals. However, GAS is not a "scale" but a heterogeneous group of methodologies, including many variations and lack of consensus on high quality GAS.

Objective: The aim of this communication is to: 1. provide updated didactical information on GAS use in PRM practice and research; 2. increase awareness of GAS methodological challenges; 3. guide use of GAS as an integrated process of rehabilitation after goal setting and; 4. provide updated resources for self-directed learning and extensive supplemental material to increase knowledge and practical skills in GAS use.

Methods: Educational literature review about current GAS applications relevant to PRM fields.

Results: Practical advice is provided regarding clinical challenges in GAS: definition of 0 level, time-frame and means employed to attain the goal, dealing with unforeseen pattern of improvement, synthesizing the numerous significations of "SMART" goal acronym to guide best use of GAS, and thinking flexibility on the type of relevant goals that can be set. Challenges with GAS in rehabilitation research are presented in order to promote researcher's and reviewer's awareness on reliable use of GAS and encouraging best-use of GAS.

Fig. 1

Examples of goal attainment scaling (GAS). Because aiming at a “0” score can be depressing for patients, Bard et al. (64) developed a stair visual analogy to facilitate patient visualization of progress on the scale, as shown in these examples.

Fig. 2

The different variants of goal attainment scaling (GAS) methodologies reported to be used in literature; these variants may concern the persons who set the goals, the types of goals set, the number of goals set, the level defined as initial level, the assessment methods, the scoring method and how the results are presented, as well as the person who finally scores the GAS.

Fig. 3

Framework for goal types. A conceptual framework for the different types of goals, that could be converted (or not converted) in a goal attainment scale (GAS). A life goal cannot be defined and measured with a time-limited scale, but the main goals should be in line with the life goal. Main goals can sometimes be directly converted into scales, or may need to be specified before being defined into a scale, or may sometimes need to be divided into subgoals. Control GASs are specific to the research context.

Fig. 4

From goal identification to goal support framework. A chronological line, on which the different steps are identified, from goal emergence to goal attainment assessment. This underlines the necessary steps prior to and after goal setting, and the unavoidable collaboration between the person being cared for and the therapeutic team.

Fig. 5

Framework for the use of goal attainment scaling (GAS) in research. Randomization can be applied in different ways: the researcher can decide to set multiple goals and then randomize the ones to be trained and the controls that will not be trained; or the researcher can set multiple goals and randomize the order in which each of them is trained, as can be done in single-case experimental designs (SCEDs), with multiple baselines across goals; or randomization can be applied between groups.