Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 54, Issue 12 M641-M647, Copyright © 1999 by The Gerontological Society of America
An individualized approach to outcome measurement in geriatric rehabilitation
P Stolee, K Stadnyk, AM Myers and K Rockwood
Southwestern Ontario Regional Geriatric Program, St. Joseph's Health Centre-Parkwood Site, London, Ontario, Canada. [email protected]
BACKGROUND: The heterogeneity of health problems experienced by frail
elderly patients makes it difficult to use a single standard measure to
evaluate multiple outcomes of geriatric rehabilitation. Commonly, several
measures are used, but an alternative is to use an individualized measure
such as Goal Attainment Scaling (GAS). This study investigated the
reliability, validity, and responsiveness of GAS as an outcome measure in
geriatric rehabilitation. METHODS: We studied 173 consecutive admissions
(mean age 81; 77% female; mean length of stay 33 days) to a geriatric
rehabilitation unit. Assessment instruments were completed at admission and
discharge. Individualized treatment goals were identified for each patient
by using GAS; standardized measures included self-rated health, a global
clinical assessment, the Barthel Index, the OARS IADL scale, the Folstein
Mini- Mental State Examination (MMSE), and the Nottingham Health Profile
(NHP). RESULTS: Mobility, future care arrangements, and functional
impairment were the most commonly identified GAS goal areas. The interrater
reliability of the GAS discharge score was 0.93. The GAS discharge score
correlated strongly (r> or =0.50) with the standardized measures, except
for self-rated health, the MMSE, and the NHP (r> or =0.31). GAS was more
responsive to change than any of the standardized measures. The GAS score
was used to derive receiver operating characteristic curves for other
measures; this can provide insight into the interpretation of clinically
important outcomes. CONCLUSIONS: GAS appears to be a feasible, reliable,
valid, and responsive approach to outcome measurement in geriatric
rehabilitation.
