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Youngsu Jung1,2*, Byungtae Ahn1, Eunyoung Park1, Jinsoo Yoon1, Jong Moon Kim1,2, MinYoung Kim1,2† |
Introduction
The Goal attainment scale (GAS) is an assessment tool that is set individually according to the patient's condition and the therapists. The GAS is appropriate for evaluating rehabilitation outcome without floor or ceiling effect, and it is also helpful in communication and collaboration between medical staff. In addition, the patient can be enrolled in the course of the treatment, and it is advantageous to be able to achieve the proper motivation. The purpose of this study is to introducing the usefulness of GAS in intensive inpatient rehabilitation of subacute post-stroke patients.
Method
From January 2015 to December 2018, we collected data of stroke patients who were hospitalized at one rehabilitation center retrospectively. Patients of 15 to 90 days after stroke onset, who had undergone rehabilitation for more than 4 weeks and had both initial and follow up evaluation were included. Poor communication and poor cognition cases in the initial evaluation were excluded. In physical therapy (PT), three specific goals were selected in the mobility (home, community), and body function (pain, posture) areas. Also in occupational therapy (OT), three specific goals in the area of upper limb function, activities of daily living. All goals were determined through active communication between patients and caregivers and medical staff. The goal attainment scale was evaluated on a 5-point scale after 4 weeks of rehabilitation. A score of 0 indicates the expected level of achievement; +1 and +2 are 'slightly' and 'much’ better than expected; -1 and -2 represent ‘slightly’ and ‘much’ lower than expected level of achievement. We analyzed whether the effects of rehabilitation treatment before (2015) and after (2016, 2017, 2018) introducing GAS were different. To confirm the usefulness of GAS, we also checked the correlation with the changes in other evaluations and the questionnaire with 13 therapists.
Result
The data before the introduction of GAS (2015) (n = 58) and the data after the introduction of GAS (2016, 2017, and 2018) (n = 141) showed no significant difference in baseline characteristics. There was no difference in improvement after rehabilitation treatment between the patients before and after the introduction of GAS (Table 1). However, most therapists answered positively about the quality of treatment and the increased participation of patients in treatment according to a questionnaire survey of therapists (Table 2). In the PT (Figure (A)) and OT (Figure (B)), the GAS standard score showed a statistically significant positive correlation with the change in ADL outcome.
Conclusion
Goal attainment scaling is a useful tool for evaluating the functional improvements of post-stroke patients in subacute period.
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Table 1. Comparison of Rehabilitation Outcomes Before and After Introduction of Goal Attainment Scale All values are presented a mean ± standard deviation. The sum of the manual muscle test by Medical Research Council (MRC) score was divided into six muscle groups including shoulder abductor of the weaker side, elbow flexor, wrist extensor, hip flexor, knee extensor, and ankle dorsiflexor. It ranges from 0 (totally hemiplegic) to 30 (normal strength). MMSE, Mini-Mental Status Exam; FMA, Fugl-Myer Assessment; MFT, Manual Function Test; MBI, Modified Barthel Index; FIM, Functional Independence Measure; MMT, Manual Muscle Test; BBS, Berg Balance Scale; TIS, Trunk Impairement Scale; FAC, Functional Ambulatory Category * p<0.05, ** p<0.01 when comparing each scores of baseline and follow-up within same group by Wilcoxon signed rank test. † compared the changes in each score (score at follow-up minus score at admission) between two groups by independent t-test.
Table 2. Distribution of questionnaire results with 5 options for therapists (n = 13) GAS, Goal attainment scaling
Figure. Correlation between GAS T score and conventional ADL outcome measurements A) Correlation between GAS T score of physical therapy and FIM - cognition, FIM - motor, and MBI B) Correlation between GAS T score of occupational therapy and FIM - cognition, FIM - motor, and MBI The standard score = 50 + {(10Σ(wixi))/(0.7Σwi2 + 0.3(Σwi)2)½} All the assigned weights (wi) were treated the same PT, Physical therapy; OT, Occupational therapy; ADL, Activities of daily living; GAS, Goal Attainment Scale; FIM, Functional Independence Measure; MBI, Modified Barthel Index
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