Goal Attainment Scaling in Rehabilitation

Abstract

Applications, controversies, and statistical issues related to goal attainment scaling (GAS) in rehabilitation are examined on the basis of available literature and outcome data from a postacute brain injury rehabilitation programme. Prior studies suggest that GAS is a promising method for measuring progress towards the type of highly individualised goals that characterise rehabilitation. GAS appears useful for (1) monitoring progress in a time-limited epoch of care, (2) structuring team conferences, (3) planning and making decisions about ongoing rehabilitation, (4) ensuring concise, relevant communication to the client, significant others, referral source, and funding sources, (5) guiding the delivery of social reinforcement, and (6) evaluating the programme. In brain injury rehabilitation specifically, the highly structured, systematic, and concrete goal-setting process provided by GAS may be helpful in (7) encouraging more accurate self-awareness, and for (8) redeveloping the capacity for goal setting. In rehabilitation settings, GAS has shown superior sensitivity to change compared to other functional outcome measures, excellent inter-rater reliability, and satisfactory concurrent validity with other outcome measures. Concerns about the idiosyncratic nature of GAS measures may not be as pertinent in rehabilitation as in mental health. For instance, the concurrent validity of GAS in rehabilitation generally appears stronger than in mental health settings. Nonetheless, GAS is probably best employed as one facet of a comprehensive outcome measurement system that also includes standardised measures of functional outcomes. The inclusion of GAS in a comprehensive outcome measurement system is recommended by its potential benefits, particularly its responsiveness to change, and its sensitivity to the values of clients.