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

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.