Goal Attainment Scaling Scores Research Articles

Ultrasound Guided Phenol Block of the Obturator Nerve for Severe Adductor Spasticity: A Pilot Study

Objective: To assess the efficacy of phenol block of the obturator nerve in treating severe adductor spasticity. Design: A prospective pilot study. Setting: Outpatient rehabilitation clinics. Participants: We recruited 5 participants with severe adductor spasticity. Four were persons with multiple sclerosis and one was a person with adult cerebral palsy. All participants were women and had an average age of 60.4 years; four participants had bilateral severe adductor spasticity and one had unilateral severe adductor spasticity. Interventions: A total of 9 phenol blocks of the obturator nerve were performed. Five were performed with ultrasound guidance, followed by localization of the obturator nerve by peripheral nerve stimulator. Four were performed using anatomic landmark and peripheral nerve stimulator for localization. Outcome Measures: The primary outcome measure was the Modified Ashworth Scale score of the hip adductor at 1 month after the obturator nerve block. The secondary outcomes measures include Modified Ashworth Scale (MAS) score of the hip adductors at 6 months, distance between the right and left medial femur condyles in supine with hip extended to neutral, Disability Assessment Scale (DAS) score, Goal Attainment Scale (GAS) score, Spasticity Numeric Rating Scale score and Subjects’ and Physician Global Impression of Changes scores. Results: There was statistically significant decrease in the MAS score at 1-month compared to baseline (2.43 vs. 4; P=0.001). There was no statistically significant difference in the secondary outcomes. There were no reported adverse effects of procedure. Conclusion: This study suggests that phenol block of the obturator nerve is effective in treating severe adductor spasticity. We recommend a larger study with more participants and longer follow up period to allow further assessment of the efficacy of the phenol block of the obturator nerve in treating severe adductor spasticity.

A protocol for a pragmatic randomized controlled trial using the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) platform approach to promote person-focused primary healthcare for older adults.

BackgroundHealthcare systems are not well designed to help people maintain or improve their health. They are generally not person-focused or well-coordinated. The objective of this study is to evaluate the effectiveness of the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) approach in older adults. The overarching hypothesis is that using the Health TAPESTRY approach to achieve better integration of the health and social care systems into a person’s life that centers on meeting a person’s health goals and needs will result in optimal aging.Methods/designThis is a 12-month delayed intervention pragmatic randomized controlled trial. The study will be performed in Hamilton, Ontario, Canada in the two-site McMaster Family Health Team. Participants will include 316 patients who are 70 years of age or older. Participants will be randomized to the Health TAPESTRY approach or control group. The Health TAPESTRY approach includes intentional, proactive conversations about a person’s life and health goals and health risks and then initiation of congruent tailored interventions that support achievement of those goals and addressing of risks through (1) trained volunteers visiting clients in their homes to serve as a link between the primary care team and the client; (2) the use of novel technology including a personal health record from the home to link directly with the primary healthcare team; and (3) improved processes for connections, system navigation, and care delivery among interprofessional primary care teams, community service providers, and informal caregivers. The primary outcome will be the goal attainment scaling score. Secondary outcomes include self-efficacy for managing chronic disease, quality of life, the participant perspective on their own aging, social support, access to health services, comprehensiveness of care, patient empowerment, patient-centeredness, caregiver strain, satisfaction with care, healthcare resource utilization, and cost-effectiveness. Implementation processes will also be evaluated. The main comparative analysis will take place at 6 months.DiscussionEvidence of the individual elements of the Health TAPESTRY platform has been shown in isolation in the previous research. However, this study will better understand how to best integrate them to maximize the system’s transformation of person-focused, primary care for older adults.Trial registrationClinicalTrials.gov NCT02283723 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0407-5) contains supplementary material, which is available to authorized users.

Feasibility and Acceptability of a Pilot Housing Transition Program for Homeless Adults with Mental Illness and Substance Use

ABSTRACTThe purpose of this study was to determine if a housing transition program was feasible and acceptable to homeless clients with mental illness and substance use histories. Ten male residents of a homeless shelter participated in the 3-week housing intervention. The intervention used a DVD format with instructional videos, graphics, and opportunities for hands-on practice of functional skills in a simulated apartment environment. Outcome measures included goal attainment scale scores (GAS), satisfaction surveys, and case manager reports. Six of the 10 participants completed the program and achieved GAS scores at a greater level than expected at baseline (T > 50). Participants reported the intervention to be engaging and enhanced their knowledge of the housing transition process. The intervention appears to have assisted the participants in the attainment of housing skills and warrants further study.

Short-term, intensive neurodevelopmental treatment program experiences of parents and their children with disabilities.

Parents' perspectives on intervention and functional changes in children were investigated following an intensive neurodevelopmental treatment (NDT) program of 1 to 2 weeks (5 consecutive days per week; 2-4 h/d). Thirteen parents and their children (aged 1-17 years) with neuromotor conditions participated in a short-term, intensive program conducted by NDT certified pediatric therapists. A mixed-method design was used: a qualitative phenomenological approach of inquiry for parent perspectives and a pre/posttest quasi-experimental design for weekly intervention changes using Goal Attainment Scaling and the Canadian Occupational Performance Measure. Through interviews, parents reported positive experiences with the intensive NDT program. Child participants demonstrated significant improvements in Goal Attainment Scaling (P < .001) and Canadian Occupational Performance Measure (P < .001) scores pre- to postintervention. A short-term, intensive NDT program was perceived by parents as beneficial and supported functional improvements. Valued were expert, compassionate therapists; collaboration; objective goals; home programming; and individualized intervention. Scheduling, financial support, and fatigue were difficulties.

PREVALENCE OF DEPRESSION AND ANXIETY AMONG OLDER ADULTS IN LEBANON: PRELIMINARY DATA FROM BEIRUT AND MOUNT LEBANON

more conservative 4 points, compared to a 3 point cut-point, did not significantly change the findings. Conclusions: A clinically meaningful response at 9 months emerged as a stable pattern of improvement and deterioration as early as 4 months into a clinical trial. In considering symptomatic treatment, the intensity and the direction of the initial treatment response appears to be important in informing long term outcomes. Of note, even a one-point change in goal attainment scaling Scores earlysuggest longer term trends.

A dual-task home-based rehabilitation programme for improving balance control in patients with acquired brain injury: a single-blind, randomized controlled pilot study

Objective: To evaluate the safety, feasibility and effectiveness of a dual-task home-based rehabilitation programme on balance impairments among adult patients with acquired brain injury. Design: Single-blind, randomized controlled pilot study. Setting: Single rehabilitation centre. Subjects: Sixteen participants between 12 and 18 months post-acquired brain injury with balance impairments and a score <10 seconds on the One-Leg Stance Test (eyes open). Intervention: All participants received 50-minutes individualised traditional physiotherapy sessions three times a week for seven weeks. In addition, the intervention group (N = 8) performed an individualised dual-task home-based programme six days a week for seven weeks. Main outcome measures: The primary outcome measure was the Balance Evaluation System Test; secondary measures were the Activities-specific Balance Confidence Scale and Goal Attainment Scaling. Results: At the end of the pilot study, the intervention group showed significantly greater improvement in Balance Evaluation System Test scores (17.87, SD 6.05) vs. the control group (5.5, SD 3.53; P = 0.008, r = 0.63). There was no significant difference in improvement in Activities-specific Balance Confidence Scale scores between the intervention group (25.25, SD 25.51) and the control group (7.00, SD 14.73; P = 0.11, r = 0.63). There was no significant improvement in Goal Attainment Scaling scores in the intervention (19.37, SD 9.03) vs. the control group (16.28, SD 6.58; P = 0.093, r = 0.63). Conclusions: This pilot study shows the safety, feasibility and short-term benefit of a dual-task home-based rehabilitation programme to improve balance control in patients with acquired brain injury. A sample size of 26 participants is required for a definitive study.

Bimanual therapy and constraint-induced movement therapy are equally effective in improving hand function in children with congenital hemiplegia

Does constraint-induced movement therapy (CIMT) improve hand function in children with congenital hemiplegia compared to bimanual therapy? Randomised trial with concealed allocation and blinded outcome assessment. 6 CIMT and bimanual therapy day camps were conducted at a University in the United States. Children with congenital hemiplegia aged 3.5 to 10 years, with basic movement and grasp in their paretic hand, and who attended mainstream school. Health problems not associated with cerebral palsy, severe hypertonia, and recent surgery or botulinum toxin therapy were exclusion criteria. Randomisation of 44 participants allocated 22 to the CIMT group and 22 to the bimanual therapy group. The groups were matched for age and hand function. Both groups received 90 hours of therapy, delivered in day-camps with 2-5 children in each group. Participants completed 6 hours of therapy a day for 15 consecutive weekdays. Treatment was delivered by physiotherapists, occupational therapists, and students enrolled in health related courses. Participants worked individually and in groups. The CIMT group had their less affected hand restrained in a sling and performed age appropriate fine and gross motor unimanual activities The bimanual therapy group engaged in age appropriate fine and gross motor bimanual activities. The primary outcomes were the Jebsen-Taylor Test of Hand Function (JTTHF) to assess unimanual capacity and the Assisting Hand Assessment (AHA) to assess bimanual performance. Secondary outcome measures were Goal Attainment Scale, Quality of Upper Extremity Skills Test (QUEST), and physical activity (percentage time each hand was used during the AHA assessment). Assessments were completed before treatment, 2 days after treatment, and 1 and 6 months after treatment. 42 participants completed the study. At the end of the 15-day intervention period, the groups did not significantly differ on the primary outcome measures and on two secondary outcome measures (QUEST, physical activity). There were significant within group changes for both groups on each primary outcome (mean change score JTTHF -137 s, 95% CI -174 to -99; mean change score AHA -0.49 logits, 95% CI 0.25 to 0.73) which were maintained at the 6 month follow-up. There were also significant within group changes for both groups for the QUEST and physical activity assessments. The bimanual therapy group made greater progress than the CIMT group on their Goal Attainment Scale scores (mean difference between groups 8.1 T-score, 95% CI 0.7 to 15.5). CIMT and bimanual therapy resulted in similar improvements in hand function among young children with congenital hemiplegia. The bimanual therapy group made better progress on established goals. [Mean difference between groups calculated by the CAP Editor].

Botulinum Toxin Type A and B for the Reduction of Hypersalivation in Children with Neurological Disorders: A Focus on Effectiveness and Therapy Adherence

Botulinum toxin (BoNT) is an established treatment option to reduce hypersalivation in children with chronic neurological disorders. Objective of this study was (1) to discriminate differences in efficacy and safety of repeated interventions using BoNT with a focus on different preparations used and (2) to look for effectiveness and treatment adherence from a qualitative research perspective in this single-center cohort study. We prospectively assessed goal attainment scaling, drooling severity and frequency score and the number of towels/day before, and 4 to 8 weeks after intervention. A parent questionnaire assessed therapy-related effects on quality of life retrospectively. A total of 19 out of 34 patients received repeated injections of BoNT (106 total). Mean dose: 95 units onabotulinumtoxinA (Botox®), 2383 units rimabotulinumtoxinB (Neuro-/Myobloc®). Outcome parameters showed a distinct reduction in all treatment groups with a higher efficacy of riB. The child's need for care was reduced in 79% and social interaction improved in 84%. Main reason for discontinuation was "not enough effect" and "formation of antibodies." riB showed to be more effective in reducing hypersalivation, but antibody-formation seems to be clinically relevant. Despite clinical efficacy treatment adherence is influenced by personal and environmental factors of parents and caretakers balancing the short-term clinical benefit versus the burden of intervention.

A systematic evaluation of the effect of thumb opponens splints on hand function in children with unilateral spastic cerebral palsy

Objective: To examine the effects of a neoprene thumb opponens splint on hand function during a self-selected activities of daily living task in children with unilateral spastic cerebral palsy with thumb-in-palm position of the affected hand. Design: Systematic evaluation of seven cases using a multiple baseline design across individuals. Setting: Outpatient clinic. Subjects: Seven children with unilateral cerebral palsy (2–7 years old), Manual Ability Classification System level 2–3 participated in the study. Interventions: Neoprene thumb opponens splints (McKie splint) were used. Children were followed for about four months. Baseline period ranged from 4 to 9 weeks, intervention period was two months and duration of follow-up one month. Main measures: Hand function was assessed using goal attainment scaling and visual analogue scales. Data was assessed visually. Results: In four children goal attainment scaling and/or visual analogue scale scores increased after introducing the splint. These effects remained when splints were not worn. Two children only benefited from the splint when it was worn. Thumb opponens splints were tolerated well by all children who participated in this study. Conclusions: Thumb opponens splints may have a positive effect on hand function in children with unilateral spastic cerebral palsy.

Responsiveness of Goal Attainment Scaling in comparison to two standardized measures in outcome evaluation of children with cerebral palsy

Objectives: To assess the responsiveness of Goal Attainment Scaling compared with the Pediatric Evaluation of Disability Inventory (PEDI) and the 66-item Gross Motor Function Measure (GMFM-66) in multidisciplinary rehabilitation practice. Design: Observational study. Pretest–posttest design. Subjects/patients: Twenty-three children with cerebral palsy, aged 2–13 years. Methods: Goal Attainment Scaling, PEDI and GMFM-66 assessments were performed before and after six months of treatment. Physical, occupational and speech therapists constructed and scored 6-point Goal Attainment Scaling scales meeting predetermined criteria, describing the main functional goal per discipline. The contents of the three measures were compared using International Classification of Functioning, Disability and Health child and youth version (ICF-CY) codes. Spearman’s rho correlations between Goal Attainment Scaling change scores per discipline and change scores obtained with the PEDI functional skills scales and GMFM-66 were calculated. Complete goal attainment was compared with significant change in terms of the standardized measures. Results: Twenty per cent of the Goal Attainment Scaling items were not covered by items of the PEDI or the GMFM-66. Inconclusive correlations were found between Goal Attainment Scaling and PEDI change scores (r 0.28–0.64). Even after exclusion of the non-corresponding items, correlations were moderate (r 0.57–0.73). Of 39/64 Goal Attainment Scaling scales scored as complete goal attainment, 16 individual PEDI scores did not show change on the corresponding scale. Low correlation was found between Goal Attainment Scaling change scores and GMFM-66 change scores. Conclusion: Goal Attainment Scaling, PEDI and GMFM-66 were complementary in their ability to measure individual change over time in children with cerebral palsy. Using only the standardized instruments could have caused many individual rehabilitation goals actually attained being missed in the outcome evaluation.

Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study.

The purpose of this pilot study was to establish a model for randomized controlled trial research, identify appropriate outcome measures, and address the effectiveness of sensory integration (SI) interventions in children with autism spectrum disorders (ASD). Children ages 6-12 with ASD were randomly assigned to a fine motor or SI treatment group. Pretests and posttests measured social responsiveness, sensory processing, functional motor skills, and social-emotional factors. Results identified significant positive changes in Goal Attainment Scaling scores for both groups; more significant changes occurred in the SI group, and a significant decrease in autistic mannerisms occurred in the SI group. No other results were significant. The study discusses considerations for designing future outcome studies for children with ASD.

An Integrated Motor Imagery Program to Improve Functional Task Performance in Neurorehabilitation: A Single-Blind Randomized Controlled Trial

Bovend'Eerdt TJ, Dawes H, Sackley C, Izadi H, Wade DT. An integrated motor imagery program to improve functional task performance in neurorehabilitation: a single-blind randomized controlled trial. Objective To investigate the feasibility of a motor imagery program integrated into physiotherapy and occupational therapy. Design A parallel-group, phase II, assessor-blind randomized controlled trial comparing motor imagery embedded in usual therapy with usual therapy only. Setting A neurologic rehabilitation center (Oxford, United Kingdom). Participants Inpatients and outpatients diagnosed with stroke, brain injury, or multiple sclerosis, participating in a rehabilitation program with sufficient language skills to undertake the intervention were recruited (N=30) and assessed at baseline, after 6 weeks (postintervention), and after 12 weeks (follow-up). Interventions A motor imagery strategy was developed that could be integrated into usual therapy, tailored to individual goals, and used for any activity. The control group received standard care. Main Outcome Measures Goal attainment scaling was used as the primary outcome measure. Other measures included the Barthel activities of daily living index and the Rivermead Mobility Index. Results Compliance with advised treatment was poor in 85% of the therapists and in 72% of the patients. Goal attainment scaling scores significantly improved at postintervention and follow-up (F 2,27=45.159; P<.001), but no significant difference was observed between the groups over time (F 1,28=.039; P=.845). Conclusions Therapist and patient compliance with performing the intervention was low, restricting the conclusions regarding the effectiveness of the integrated motor imagery program. Future studies will need to explore barriers and facilitators to uptake of this intervention in clinical practice. Trial recruitment and retention were good. The study demonstrated that imagery could be successfully integrated into usual therapy and tailored for a wide range of functional activities.

Goal attainment scaling as a measure of treatment success after physiotherapy for chronic low back pain

In some chronic conditions, patient-specific tools with individualized items have proved to be more sensitive outcome instruments than fixed-item tools; their use has not yet been investigated in chronic low back pain (cLBP). Eleven males and 21 females [mean age 44.0 (12.3) years] with cLBP, undergoing a spine-stabilization physiotherapy programme, completed the Roland Morris (RM) Disability Scale and a 0-10 pain scale pre- and post-therapy. Post-therapy, goal attainment scaling (GAS) scores were calculated regarding achievement of 2-6 priority GAS goals established pre-therapy; global outcome of therapy was assessed on a 5-point Likert scale. Approximately one-fifth of the individualized goals were not covered by items of the RM. Of the 121 individualized goals, 41 (34%) were achieved at the expected level, 42 (35%) were exceeded and 38 (31%) were not reached. GAS scores correlated with change scores for pain (r = 0.61, P < 0.0001) and RM (r = 0.49, P = 0.006). Sixty-five per cent of the patients had a successful outcome according to GAS (i.e. a score >or=50); 55%, according to global outcome (therapy helped/helped a lot); 39%, according to the RM score change (score decrease >or=30%); and 44%, according to the pain score change (score decrease >or=30%). GAS demonstrates the achievement of important goals undetected by fixed-item measures and is a valid and sensitive outcome measure for assessing the success of rehabilitation in patients with cLBP.

The practical use of goal attainment scaling for people with acquired brain injury who receive cognitive rehabilitation

Objective: To examine the feasibility of and clinical experiences with goal attainment scaling when used for the evaluation of cognitive rehabilitation in people with acquired brain injury. Design: A prospective observational longitudinal study. Setting: A 21-week cognitive rehabilitation programme and a cognitive programme with varying length in two different Dutch rehabilitation centres. Subjects: Forty-eight consecutive patients with acquired brain injury enrolled during a 15-month period. Interventions: Cognitive rehabilitation programme. Main measure: Goal attainment scaling; the number of goals was counted; time to set goals was recorded; the number of different domains in which goals were set was counted; goal attainment scaling score was calculated at baseline, one week after the end of the cognitive rehabilitation programme and at six months follow-up; clinical experiences that could be useful for both clinical and research practice were recorded. Results: The mean (SD) age of the patients was 46.1 (10.7) years; 29 (60%) were male; 186 goals were set with a mean (SD) number of 4 (1) goals per patient. It was possible to set at least three realistic goals per patient within 30 minutes. Most goals were set in the cognitive domain (i.e. memory and attention), followed by the behavioural domain (i.e. fatigue and aggression). Conclusion: It proved possible to set three goals within an acceptable time-frame, to involve patients in the goal-setting procedure, to set realistic goals, and to set goals within relevant domains. Based on clinical experiences, goal attainment scaling is less feasible for research when patients lack insight, or suffer from comorbidity or mood problems.

Assessing clinically meaningful change following a programme for managing chronic pain

Objectives: (1) To identify criteria for clinically meaningful change scores in commonly used measures of pain and related disability, using Goal Attainment Scaling as an external indicator of success. (2) To investigate the chances of achieving these scores following a pain management programme versus remaining on the waiting list. Design: Participants were assessed on entry to waiting list, on admission and at follow-up from the pain management programme. Three groups of Goal Attainment Scaling scores (-1.0, +1) were created from final Goal Attainment Scaling achievements. Mean scores on other measures were analysed in relation to Goal Attainment Scaling score groups by ANOVA. Differences in numbers achieving clinically meaningful changes when on the pain management programme or waiting list were compared. Subjects: Chronic musculoskeletal pain participants (N = 73) attending a rehabilitation centre, mean age (range) 44.8 (24—70) years, mean age (range) 44.8 (24—70), mean pain duration 7.7 (1—32) years. Intervention: Three-week (15-day) pain management programme based on cognitive behavioural principles. Measures: McGill Pain Questionnaire, 0—10 Pain Intensity Numerical Rating Scale (NRS), Oswestry Disability Questionnaire (ODQ), General Health Questionnaire (GHQ), 5 minute walk, 1 minute sit/stand, 1 minute stair-climbing, and Goal Attainment Scaling (GAS). Results: Mean change scores differed significantly for three GAS groups and were highest in the most successful (+1) group. These scores were used to define clinically meaningful changes on the NRS (-3), ODQ (-12), walk (+87) and stairs (+14). Significantly more participants on the pain management programme achieved these scores than those on the waiting list. Conclusion: Using GAS as a criterion of patient-perceived improvement enabled identification of clinically meaningful changes on some other common measures. These successfully differentiated achievement between patients on the pain management programme and those on the waiting list.

Adapting the Canadian Occupational Performance Measure for use in a paediatric clinical trial

Background. The Canadian Occupational Performance Measure (COPM) is a commonly used outcome measure in rehabilitation. In this study it was adapted for very young children by deleting paid/unpaid work and household management categories and having parents act as proxies to rate child performance and their own satisfaction.Purpose. To assess the internal consistency reliability, content and construct validity, responsiveness, and impact of half scores (20 not 10-point scale) of the adapted COPM.Method. Parent proxies of subjects aged 2 – 8 (mean 3.9) years with spastic hemiplegic cerebral palsy (n = 41) participating in a clinical trial. There was a total of 214 occupational performance problems for analysis and an additional 56 which had used half score ratings. Internal consistency reliability and construct validity were evaluated using Cronbach alpha statistic. Proxy views explored content validity. Responsiveness was evaluated using pre-post intervention scores and a comparison with Goal Attainment Scaling scores which were assumed to be a suitable benchmark measure. The effect of half scores was assessed by two-sample t-tests.Results. The COPM adaptations did not have a negative impact on internal consistency reliability as this was acceptable for performance (0.73) and satisfaction (0.83). The high Cronbach alpha scores indicated good construct validity. Content of occupations and rating approach was considered valid by proxies. Use of half scores did not result in significantly different performance ratings, but mean satisfaction ratings were significantly higher when half scores were used (p = 0.0001). This suggests that half scores may provide more precise proxy satisfaction ratings, but at the cost of rigour as internal consistency with satisfaction half scores was lower (0.63 vs. 0.82). Responsiveness to change in clinical status was demonstrated by significant pre-post scores and moderate correlations with goal attainment scores.Conclusion. The adapted COPM is a psychometrically robust tool and the use of half scores is not recommended.

Treatment of Spastic Equinus Gait with Botulinum Toxin A: Does Dose Matter? Analysis of a Clinical Cohort

This study reports the effects of various doses of BTX-A when treating equinus gait in cerebral palsy in a clinical setting at a tertiary hospital. Twenty-nine children with CP (age 1.5-9.6 yrs, GMFCS I-IV) met the preset inclusion criteria. The treatment episodes per child ranged from 1 to 5 and the effects on a total of 80 legs in 55 treatment sessions were evaluated. BTX-A doses injected into the gastroc-soleus muscle were divided into low- (<or= 6 units/kg bw) and high- (> 6 units/kg bw) dose groups. The outcome measurements included active and passive ankle range of movement, Modified Ashworth Scale, dynamic muscle length, Selective Motor Control score, Observational Gait Scale score, and Goal Attainment Scale score at pre-treatment and 1, 2, and 4 months post-treatment. The only differences between the treatment groups were observed at 2 and 4 months in terms of change in passive ankle ROM and at 4 months in change in selective dorsiflexion, favouring the low-dose group. The incidence and severity of side-effects did not differ between the groups. Doses over 6 units/kg bw injected into the gastroc-soleus muscle do not necessarily yield superior results compared with lower doses.

Attainment of treatment goals by people with Alzheimer's disease receiving galantamine: a randomized controlled trial

Although cholinesterase inhibitors have produced statistically significant treatment effects, their clinical meaningfulness in Alzheimer's disease is disputed. An important aspect of clinical meaningfulness is the extent to which an intervention meets the goals of treatment. In this randomized controlled trial, patients with mild to moderate Alzheimer's disease were treated with either galantamine or placebo for 4 months, followed by a 4-month open-label extension during which all patients received galantamine. The primary outcome measures were Goal Attainment Scaling (GAS) scores from assessments by clinicians and by patients or caregivers of treatment goals set before treatment and evaluated every 2 months. Secondary outcome measures included the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Clinician's Interview-based Impression of Change plus Caregiver Input (CIBIC-plus), the Disability Assessment for Dementia (DAD) and the Caregiving Burden Scale (CBS). To evaluate treatment effect, we calculated effect sizes (as standardized response means [SRMs]) and p values. Of 159 patients screened, 130 (mean age 77 [standard deviation (SD) 7.7]; 63% women) were enrolled in the study (64 in the galantamine group and 66 in the placebo group); 128 were included in the analysis because they had at least one post-baseline evaluation. In the intention-to-treat analysis, the clinician-rated GAS scores showed a significantly greater improvement in goal attainment among patients in the galantamine group than among those in the placebo group (change from baseline score 4.8 [SD 9.6]) v. 0.9 [SD 9.5] respectively; SRM = 0.41, p = 0.02). The patient- caregiver-rated GAS scores showed a similar improvement in the galantamine group (change from baseline score 4.2 [SD 10.6]); however, because of the improvement also seen in the placebo group (2.3 [SD 9.0]), the difference between groups was not statistically significant (SRM = 0.20, p = 0.27). Of the secondary outcome measures, the ADAS-cog scores differed significantly between groups (SRM = -0.36, p = 0.04), as did the CIBIC-plus scores (SRM = -0.40, p = 0.03); no significant differences were in either the DAD scores (SRM = 0.28, p = 0.13) or the CBS scores (SRM = -0.17, p = 0.38). Clinicians, but not patients and caregivers, observed a significantly greater improvement in goal attainment among patients with mild to moderate Alzheimer's disease who were taking galantamine than among those who were taking placebo.

The effect of botulinum toxin type A treatment of the lower extremity on the level of functional abilities in children with cerebral palsy: evaluation with goal attainment scaling

To measure the effect of botulinum toxin type A (BTX-A) treatment in children with cerebral palsy with regard to individual goals concerning functional abilities, using goal attainment scaling. A single-blind randomized multiple baseline/treatment phase design across subjects. The paediatric department of a rehabilitation centre. Eleven children with cerebral palsy participated. BTX-A treatment of the lower extremity. A six-point goal attainment scaling of three individual treatment goals at the level of functional abilities. Standardized video-tapes of each goal were recorded weekly for a period of 14 weeks. Rating on the predetermined goal attainment scaling was blinded. Nine of the 11 subjects showed significant improvement in 18 out of 33 goals. Seven subjects showed clinically relevant improvement (at least 2 points on the goal attainment scaling) in 11 goals. Testing the difference between all medians of baseline measurements (after correction for improvement during baseline) and the medians of the treatment phase measurements for all goal attainment scaling scores (n = 33) resulted in significant improvement (p < 0.001). Tested at subject level (medians of the three goal attainment scaling scores per assessment, n = 11), a significant improvement was also found (p = 0.005). The change in goal attainment scaling score was related to the moment of treatment with BTX-A. Clinically relevant improvement in individual rehabilitation goals at ability level, achieved with the treatment of BTX-A in children with cerebral palsy, were demonstrated using the goal attainment scaling method.

Operationalizing a Frailty Index from a Standardized Comprehensive Geriatric Assessment

To construct and validate a frailty index (FI) that is clinically sensible and practical for geriatricians by basing it on a routinely used comprehensive geriatric assessment (CGA) instrument. Secondary analysis of a 3-month randomized, controlled trial of a specialized mobile geriatric assessment team. Rural Nova Scotia. Participants were seen in their homes. Frail older adults, of whom 92 were in the intervention group and 77 in the control group. A standard CGA form that accounts for impairment, disability, and comorbidity burden was scored and summed as a frailty index (FI-CGA). The FI-GCA was stratified to describe three levels of frailty. Patients were followed for up to 12 months to determine how well the index predicted adverse outcomes (institutionalization or mortality, whichever came first). The three levels of frailty were mild (FI-CGA 0-7), moderate (FI-CGA 7-13), and severe (FI-CGA>13). Demographic and social traits were similar across groups, but greater frailty was associated with worse function (r=0.55) and mental status (r=0.33). Those with moderate and severe frailty had a greater risk of adverse outcomes than those with mild frailty (unadjusted hazard ratio=1.9 and 5.5, respectively). There was no difference between frailty groups in mean 3-month goal-attainment scaling scores. Intrarater reliability was 0.95. The FI-CGA is a valid, reliable, and sensible clinical measure of frailty that permits risk stratification of future adverse outcomes.