Use of goal attainment scaling in measuring clinically important change in cognitive rehabilitation patients

Measuring the effectiveness of cognitive rehabilitation programs poses both conceptual and practical challenges. We compared several standardized outcome measures with goal attainment scaling (GAS) to assess their sensitivity to changes in health status in patients undergoing cognitive rehabilitation. GAS is a measurement approach that accommodates multiple individual patient goals, and has a scoring system which allows for comparisons between patients. Forty-four patients were evaluated. GAS yielded a mean 4.4 goals per patient. The mean gain in the GAS score was compared with the change in the Rappaport Disability Rating Scale, the Kohlman Evaluation of Daily Living Skills, the Milwaukee Evaluation of Daily Living, the Klein-Bell elimination scale and mobility scale, the Instrumental Activities of Daily Living Scale, and the Spitzer Quality of Life Index. Using a relative efficiency statistic, GAS proved more responsive than any other measure. The effect size statistic also demonstrated greater responsiveness to change with GAS compared with standard measures. GAS shows promise as a responsive measure in cognitive rehabilitation. This study replicates a similar study of GAS in frail elderly patients, suggesting that individualized measures may have broad merit in evaluating rehabilitation programs.