You are not logged in. Press here to login.


List volumes - List articles in this issue

Original report

Goal attainment scaling: Does it provide added value as a person-centred measure for evaluation of outcome in neurorehabilitation following acquired brain injury?

doi: 10.2340/16501977-0383

Open access


OBJECTIVE: To compare goal attainment scaling (GAS) and standardized measures in evaluation of person-centred outcomes in neurorehabilitation.
DESIGN: A prospective cohort analysis from a tertiary inpatient neuro-rehabilitation service for younger adults with complex neurological disability.
SUBJECTS/PATIENTS: Consecutive patients (n = 164) admitted for rehabilitation following acquired brain injury (any cause) over 3 years. Mean age 44.8 (standard deviation 14.4) years. Diagnosis: 66% strokes, 18% trauma, 16% other. Male:female ratio 102:62.
METHODS: GAS-rated achievement of 1–6 patient-selected goals was compared with the Functional Assessment Measure (UK FIM+FAM), and Barthel Index (BI), rated on admission and discharge. Personal goals were mapped retrospectively to the FIM+FAM and International Classification of Functioning, Disability and Health (ICF).
RESULTS: Median (interquartile range; IQR) GAS T-scores were 50.0 (44.2–51.8) and moderately correlated with changes in FIM+FAM and BI (both rho 0.38 (p < 0.001)). Standardized response means were 2.2, 1.6 and 1.4 for GAS, FIM+FAM and BI, respectively. Of 667 personal goals set, 495 (74%) were fully achieved. Although 413 (62%) goals were reflected by changes in FIM+FAM, over one-third of goals were set in other areas.
CONCLUSION: GAS appeared to be more responsive, and captured gains beyond the FIM+FAM, thus providing added value as an adjunct to outcome measurement in patients with complex disability.


Lynne Turner-Stokes, Heather Williams, Jane Johnson


  1. Wade DT. Evidence relating to goal-planning in rehabilitation. Clin Rehabil 1998; 12: 273–275.
  2. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J 1965; 14: 61–65.
  3. Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C. Relationships between impairment and physical disability as measured by the Functional Independence Measure. Arch Phys Med Rehabil 1993; 74: 566–573.
  4. Turner-Stokes L. Outcome measurement in brain injury rehabilitation – towards a common language. Clin Rehabil 1999; 13: 273–275.
  5. Turner-Stokes L, Nyein K, Turner-Stokes T, Gatehouse C. The UK FIM+FAM: development and evaluation. Functional Assessment Measure. Clin Rehabil 1999; 13: 277–287.
  6. Willer B, Button J, Rempel R. Residential and home-based postacute rehabilitation of individuals with traumatic brain injury: a case control study. Arch Phys Med Rehabil 1999; 80: 399–406.
  7. Hall KM, Mann N, High WMJ, Wright J, Kreutzer JS, Wood D. Functional measures after traumatic brain injury: Ceiling effects of FIM, FIM+FAM, DRS, and CIQ. J Head Trauma Rehabil 1996; 11: 27–39.
  8. Hurn J, Kneebone I, Cropley M. Goal setting as an outcome measure: a systematic review. Clin Rehabil 2006; 20: 756–772.
  9. Kiresuk T, Sherman R. Goal attainment scaling: a general method of evaluating comprehensive mental health programmes. Com Mental Health J 1968; 4: 443–453.
  10. Rockwood K, Stolee P, Fox RA. Use of goal attainment scaling in measuring clinically important change in the frail elderly. J Clin Epidemiol 1993; 46: 1113–1118.
  11. Schlosser RW. Goal attainment scaling as a clinical measurement technique in communication disorders: a critical review. J Commun Disord 2004; 37: 217–239.
  12. Malec JF, Smigielski JS, DePompolo RW. Goal attainment scaling and outcome measurement in postacute brain injury rehabilitation. Arch Phys Med Rehabil 1991; 72: 138–143.
  13. Steenbeek D, Ketelaar M, Galama K, Gorter JW. Goal attainment scaling in paediatric rehabilitation: a critical review of the literature. Dev Med Child Neurol 2007; 49: 550–556.
  14. Shefler G, Canetti L, Wiseman H. Psychometric properties of goal-attainment scaling in the assessment of Mann’s time-limited psychotherapy. J Clin Psychol 2001; 57: 971–979.
  15. Palisano RJ. Validity of goal attainment scaling in infants with motor delays. Phys Ther 1993; 73: 651–658; discussion 658–660.
  16. Rockwood K, Howlett S, Stadnyk K, Carver D, Powell C, Stolee P. Responsiveness of goal attainment scaling in a randomized controlled trial of comprehensive geriatric assessment. J Clin Epidemiol 2003; 56: 736–743.
  17. Mackay G, Somerville W. Reflections on goal attainment scaling. Educational Res 1996; 2: 161–171.
  18. Steenbeek D, Meester-Delver A, Becher JG, Lankhorst GJ. The effect of botulinum toxin type A treatment of the lower extremity on the level of functional abilities in children with cerebral palsy: evaluation with goal attainment scaling. Clin Rehabil 2005; 19: 274–282.
  19. Tennant A. Goal attainment scaling: current methodological challenges. Disabil Rehabil 2007; 29: 1583–1588.
  20. Yip AM, Gorman MC, Stadnyk K, Mills WG, MacPherson KM, Rockwood K. A standardized menu for Goal Attainment Scaling in the care of frail elders. Gerontologist 1998; 38: 735–742.
  21. World Health Organization. International classification of functioning, disability and health. Geneva: World Health Organization; 2002. Report no.: ISBN 91 4 154542 9.
  22. Ashford S, Turner-Stokes L. Goal attainment for spasticity management using botulinum toxin. Physiother Res Int 2006; 11: 24–34.
  23. Turner-Stokes L. Goal attainment scaling in rehabilitation; a practical guide. Clin Rehabil 2009; 23: 362–370.
  24. Rockwood K, Joyce B, Stolee P. Use of goal attainment scaling in measuring clinically important change in cognitive rehabilitation patients. J Clin Epidemiol 1997; 50: 581–588.
  25. Rushton PW, Miller WC. Goal attainment scaling in the rehabilitation of patients with lower-extremity amputations: a pilot study. Arch Phys Med Rehabil 2002; 83: 771–775.
  26. Hawley CA, Taylor R, Hellawell DJ, Pentland B. Use of the functional assessment measure (FIM+FAM) in head injury rehabilitation: a psychometric analysis. J Neurol Neurosurg Psychiatr 1999; 67: 749–754.
  27. Nyein K, McMichael L, Turner-Stokes L. Can a FIM score be converted to a Barthel Index? Clin Rehabil 1999; 13: 56–63.
  28. Collin C, Wade DT, Davis S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud 1988; 10: 61–63.
  29. Gordon JE, Powell C, Rockwood K. Goal attainment scaling as a measure of clinically important change in nursing-home patients. Age Ageing 1999; 28: 275–281.
  30. Cieza A, Brockow T, Ewert T, Amman E, Kollerits B, Chatterji S, et al. Linking health-status measurements to the international classification of functioning, disability and health. J Rehabil Med 2002; 34: 205–210.
  31. Stucki G, Grimby G. Forward: Applying the ICF in medicine. J Rehabil Med 2004; 36: 5–6.
  32. Soberg HL, Finset A, Roise O, Bautz-Holter E. Identification and comparison of rehabilitation goals after multiple injuries: an ICF analysis of the patients’, physiotherapists’ and other allied professionals’ reported goals. J Rehabil Med 2008; 40: 340–346.
  33. Cohen J, editor. Statistical power analysis for the behavioural sciences. 2nd edn. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
  34. Kiresuk T, Smith A, Cardillo J, editors. Goal attainment scaling: application, theory and measurement. New York: Lawrence Erlbaum Associates; 1994.
  35. Hobart JC, Lamping DL, Freeman JA, Langdon DW, McLellan DL, Greenwood RJ, et al. Evidence-based measurement: which disability scale for neurologic rehabilitation? Neurol 2001; 57: 639–644.
  36. Linn RT, Blair RS, Granger CV, Harper DW, O’Hara PA, Maciura E. Does the functional assessment measure (FAM) extend the functional independence measure (FIM) instrument? A Rasch analysis of stroke inpatients. J Outcome Meas 1999; 3: 339–359.
  37. Granger CV. A conceptual model for functional assessment. In: Granger CV & Gresham GE, editors. Functional assessment in rehabilitation medicine. Baltimore: Williams and Wilkins; 1984.
  38. Schepers VP, Ketelaar M, van de Port IG, Visser-Meily JM, Lindeman E. Comparing contents of functional outcome measures in stroke rehabilitation using the International Classification of Functioning, Disability and Health. Disabil Rehabil 2007; 29: 221–230.
  39. Boldt C, Brach M, Grill E, Berthou A, Meister K, Scheuringer M, et al. The ICF categories identified in nursing interventions administered to neurological patients with post-acute rehabilitation needs. Disabil Rehabil 2005; 27: 431–436.
  40. Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning, Disability and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil Med 2008; 44: 329–342.

Related articles

There are no related articles.



Full text



There is no supplementary for this article.

Related articles

Click here to show related articles

Print information

Volume 41, Issue 7

DOI: 10.2340/16501977-0383

Pages: 528-535

View at PubMed