Goal attainment scaling as a measure of clinically important change in nursing-home patients.

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Abstract

OBJECTIVES:To assess the feasibility, validity and responsiveness of an individualized measure--goal attainment scaling-in long-term care. DESIGN: Prospective descriptive study. SETTING: One academic and three community-based long-term care facilities. SUBJECTS: 53 nursing-home patients seen in consultation between July 1996 and June 1997. INTERVENTION: Specialized geriatric medicine consultation. MAIN OUTCOME MEASURES: Effect size and relative efficiency of the Barthel index, hierarchical assessment of balance and mobility, global deterioration scale, axis 8 (behaviour) of the brief cognitive rating scale, cumulative illness rating scale and the goal attainment scale. RESULTS: Mean goal attainment scale at follow-up was 46+/-7. The goal attainment scale was the most responsive measure, with an effect size of 1.29 and a relative efficiency of 53.7. The goal attainment scale did not correlate well with the other measures (-0.22 to 0.17). CONCLUSION: Goal attainment scaling is a feasible and responsive measure in long-term care. Although fewer problems in nursing-home patients than elderly inpatients are susceptible to intervention, clinically important goals can be achieved in this population.

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