An individualized approach to outcome measurement in geriatric rehabilitation

Background The heterogeneity of health problems experienced by frail elderl y patients makes it difficult to use a single standard measure to evaluate multiple outcomes of geriatric rehabilitation. Commonly, several measures a re used, but an alternative is to use an individualized measure such as Goa l Attainment Scaling (GAS). This study investigated the reliability, validi ty, and responsiveness of GAS as an outcome measure in geriatric rehabilita tion. Methods. We studied 173 consecutive admissions (mean age 81; 77% female; me an length of stay 33 days) to a geriatric rehabilitation unit. Assessment i nstruments were completed at admission and discharge. Individualized treatm ent goals were identified for each patient by using GAS; standardized measu res included self-rated health, a global clinical assessment, the Barthel I ndex, 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 stron gly (r greater than or equal to 0.50) with the standardized measures, excep t for self-rated health, the MMSE, and the NHP (r greater than or equal to 0.31). GAS was more responsive to change than any of the standardized measu res. The GAS score was used to derive receiver operating characteristic cur ves 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.