Detecting change in patient outcomes in a rural ambulatory rehabilitation service: the responsiveness of Goal Attainment Scaling and the Lawton Scale
Louis Baggio A C and David J. Buckley B
+ Author Affiliations
- Author Affiliations
A Rehabilitation Unit, Wagga Wagga Health Service, PO Box 159, Wagga Wagga, NSW 2650, Australia.
B Clinical Governance Unit, Murrumbidgee Local Health District, 63–65 Johnstone Street, Wagga Wagga, NSW 2650, Australia. Email: david.buckley@gsahs.health.nsw.gov.au
C Corresponding author. Email: louis.baggio@gsahs.health.nsw.gov.au
Australian Health Review 40(1) 63-68 https://doi.org/10.1071/AH14218
Submitted: 10 November 2014 Accepted: 4 May 2015 Published: 29 June 2015
Abstract
Objective The Wagga Wagga Ambulatory Rehabilitation Service (WWARS) clinicians felt the Australian Modified Lawton’s Instrumental Activities of Daily Living Scale (Lawton Scale) was unresponsive to changes detected in many patients following their individualised programs. This study examined the performance of the Goal Attainment Scaling (GAS) concomitantly with the Lawton Scale in ambulatory rehabilitation patients.
Methods Consecutive patients (n = 83) of WWARS were evaluated pre and post treatment with the Lawton Scale and GAS. The statistical properties, particularly responsiveness, of the scales were compared.
Results Statistically significant change (P < 0.001) was observed following treatment on both the Lawton Scale and GAS. Mean GAS scores changed by 38.7% compared with 8.3% for the Lawton Scale. GAS demonstrated a greater effect size (Cliff’s δ) of 1.67 (95% confidence interval 1.51–1.91) than the Lawton Scale 0.83 (95% confidence interval 0.57–0.94). In 33.7% of patients, the Lawton Scale was invariant but improved with GAS.
Conclusions GAS was a more responsive measure than the Lawton Scale in rural ambulatory rehabilitation patients. Consequently, GAS is recommended as a performance outcome measure in the evaluation of ambulatory rehabilitation services to supplement standardised outcome measures such as the Lawton Scale.
What is known about the topic? GAS has been shown to be more responsive in detecting changes in patient outcomes than the original Lawton’s Instrumental Activities of Daily Living Scale when assessing the requirements of the elderly for geriatric services and for people with acquired brain injury undergoing cognitive rehabilitation. Its responsiveness in patients with greater casemix diversity, such as those found in rural ambulatory rehabilitation services, remains uncertain.
What does this paper add? This study demonstrates GAS is more responsive than the Lawton Scale for detecting clinically meaningful change in a rural Australian ambulatory rehabilitation service delivering programs to people with heterogeneous goals.
What are the implications for practitioners? GAS facilitates the delivery of patient-centred care, accommodates the heterogeneity of patient-centred goals for evaluation, and better measures goal-achievement. Global standardised measures such as the Lawton Scale may be useful for the comparison of differing patient populations, but a weakness is they may not capture the individualised goals valued by each patient seen in rehabilitation. Consequently, GAS should be considered as an additional outcome measure in the evaluation of ambulatory rehabilitation services in assessing program effectiveness and possibly for service comparison. Furthermore, ongoing training and support in GAS application should be provided to ensure the maintenance of accurate goal setting and scaling.
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