Goal attainment scaling in evaluating a multidisciplinary pain management programme.

Abstract

To examine the value of Goal Attainment Scaling (GAS) as a therapeutic tool and an outcome measure in a rehabilitation programme in the management of chronic pain. A prospective observational study. A 15-day pain management programme, day case or residential, in an NHS Regional rehabilitation centre. One hundred and forty-nine consecutive patients enrolled during a 15-month period. Multidisciplinary structured educational programme of physiotherapy, occupational therapy and clinical psychology. GAS; timed tests of physical mobility measures; McGill Pain Questionnaire (MPQ); Pain Intensity Numerical Rating Scale (NRS); Oswestry low back pain Disability Questionnaire (ODQ); General Health Questionnaire (GHQ); Pain and Impairment Relationship Scale (PAIRS). GAS and physiotherapy measures were compared with baseline data at enrollment and at discharge 15 days later. At six-month follow-up all measures were repeated. Significant improvements at discharge were found for GAS, and physiotherapy measures. One hundred and twelve patients returned for review at six months, when improvements were maintained for GAS, sit/stand, Pain, ODQ and GHQ. GAS was shown to be a valid measure of ability, correlating significantly with walking improvement and somewhat less with a therapist-defined measure, suggesting some ability to discriminate. The improvement measured by GAS showed that patients were enabled by the programme to achieve personally valued goals over a six-month period and to improve on these more than on other more conventional outcome measures.