The responsiveness of goal attainment scaling using just one goal in controlled clinical trials: an exploratory analysis

Lisa Mcgarrigle,Kenneth Rockwood

doi:10.1186/s41687-020-00196-8

Abstract

BackgroundGoal Attainment Scaling (GAS) is an individualized outcome measure that allows the setting of personalized treatment goals. We compared the responsiveness of GAS when individuals set only one goal instead of the recommended three or more goals.MethodsWe conducted exploratory analyses on data from two randomized controlled trials: the Video-Imaging Synthesis of Treating Alzheimer’s Disease (VISTA) (n = 130); and the Mobile Geriatric Assessment Team (MGAT) (n = 265). Independent t-tests and standardized response means (SRMs) were used to assess responsiveness of one- vs. multiple-goal GAS.ResultsIn VISTA, clinician-rated multiple-goal GAS detected higher goal attainment in the intervention group (p = 0.01; SRM = 0.48). One-goal GAS, whether rated by patients or by clinicians, did not detect differences in goal attainment between groups (patient: p = 0.56, SRM = 0.10; clinician: p = 0.10, SRM = 0.29). In MGAT, multiple-goal GAS (outcome goals: p < .001, SRM = 1.29; total goals: p < .001, SRM = 1.52) and one-goal GAS (outcome goals: p < .001, SRM = 0.89; total goals: p < .001, SRM = 0.75), detected significantly higher goal attainment in the intervention group.ConclusionOne-goal GAS detected significant change in response to a patient-centred, multi-domain care initiative. As such, in similar contexts, one-goal GAS may be an effective means of optimizing personalization and improving GAS feasibility through reduced administration time. However, it is not yet clear if one-goal GAS is responsive in the context of a pharmacological intervention and further research is recommended.

Highlights

As people age, they accumulate health deficits, so that single-system illness is not commonly the norm
The study samples Exploratory analyses were conducted on data from two randomized controlled trials in which Goal Attainment Scaling (GAS) was the primary outcome measure: the Video-Imaging Synthesis of Treating Alzheimer’s Disease (VISTA) study, a 4-month, double-blind, placebo-controlled trial of galantamine in community-dwelling, mild to moderate AD patients; and the Mobile Geriatric Assessment Team (MGAT) study, a randomized, controlled trial that examined the effect that recommendations based on the Comprehensive Geriatric Assessment (CGA) had on achieving patientcentred goals in rural, community-dwelling frail older adults
One-goal GAS, whether rated by patients or clinicians, did not detect significant differences in goal attainment between groups, responsiveness was within the rubric of a small effect size

Summary

Introduction

They accumulate health deficits, so that single-system illness is not commonly the norm. GAS guidelines recommend setting three or more goals [7], this may lead to longer administration times and, in some cases, reduced personalization An example of this was encountered in a recent hemophilia study [5], where many participants, especially adolescent males, objected to having to set multiple goals, instead preferring to focus on only one target goal that was especially important to them. We report on the gains and losses in responsiveness in relation to the amount of GAS goals set (one or multiple) in two RCTs: one employed a pharmacological intervention in individuals with Alzheimer’s disease, and the other evaluated a patient-centred care initiative in older adults living with frailty. Goal Attainment Scaling (GAS) is an individualized outcome measure that allows the setting of personalized treatment goals. We compared the responsiveness of GAS when individuals set only one goal instead of the recommended three or more goals

Methods

Results

Discussion

Conclusion