Goal attainment scaling in brain injury rehabilitation: strengths, limitations and recommendations for future applications.

There is increasing emphasis on the need to identify, work with and evaluate rehabilitation outcomes in ways that are personally relevant to individuals with brain injury, whether this be at a global or individual client level. This paper focuses on the use of one such method, Goal Attainment Scaling (GAS). It provides a general review of GAS and discusses what we found to be the strengths and limitations of using GAS to assess functional improvements in a rehabilitation study. Strengths included enabling the measurement of goal accomplishment on meaningful daily activities, capturing improvement on relevant functional tasks more effectively than broad measures of impairment, and facilitating collaborative goal-setting. Limitations included the time required to identify goals that could be broken down into five GAS outcome levels and defining the five levels, and compromised assessment of goal attainment due to poorly constructed GAS scales. Recommendations for minimising these potential limitations in future applications of GAS are also discussed. They include setting GAS baseline levels consistently across all scales, assigning GAS weights based on the client's ratings of importance, reviewing GAS weightings prior to each measurement phase, and using a suggested checklist to minimise the likelihood of poorly constructed scales.