The original Goal attainment scaling was developed by Kiresuk and Sherman specifically for identifying patient specific goals in a mental health care setting.
Source references
- Kiresuk TJ, Sherman RE. Goal Attainment Scaling: A general method for evaluating comprehensive community mental health programs. Community Mental Health Journal 1968; 4 (6): 443-453 doi: 10.1007/BF01530764.
Goal Attainment Scaling – light
The GAS-light was developed following feedback from clinicians to address the following criticisms of the original version:
- It was too time-consuming to draw up goal descriptors for the full follow-up guide
- Clinicians disliked the 5-point numerical scale which did not mirror their clinical reasoning
- They were particularly put off by the complicated formula to derive the T-score
- The inclusion of goal weighting (particularly the ‘difficulty’ ratings) within the formula had a perverse effect on the total score when goals were not achieved as expected
Source references
- Turner-Stokes L. Goal Attainment Scaling (GAS) in rehabilitation: a practical guide. Clinical Rehabilitation 2009; 23: 362-370 doi: 10.1177/0269215508101742.
Goal Attainment Scaling - Evaluation of Outcome for Upper limb Spasticity - GAS-eous
Data from a series of studies including the Upper Limb International Spasticity (ULIS) programme provided a rich database of over 1700 goal statements set in the context of clinical management of upper limb spasticity.
Goals analysis revealed six main goal areas. Further analysis of the SMART goal statements within each area was used to formulate the sub-categories and recommended goal parameters.
Source references
- Turner-Stokes, Ashford, S., Jacinto, J., Maisonobe, P., Balcaitiene, J., & Fheodoroff, K. (2016). Impact of integrated upper limb spasticity management including botulinum toxin A on patient-centred goal attainment: rationale and protocol for an international prospective, longitudinal cohort study (ULIS-III). BMJ Open, 6(6), e011157–. https://doi.org/10.1136/bmjopen-2016-011157.
- Ashford S, Fheodoroff K, Jacinto J, Turner-Stokes L. Common goal areas in the treatment of upper limb spasticity: A multicentre analysis. Clinical Rehabilitation 2016; 30 (6): 617-622 doi: 10.1177/0269215515593391.
Goal Attainment Scaling – GAS-legs
Further development for identification of commonly selected goals in the management of lower limb spasticity with the incorporation of botulinum toxin was completed.
This involved a two-stage process:
- A retrospective review of goals set in 3 busy clinical environments in the UK
- Prospective data collection
Goal categories and domains were identified.
The goal categories were further mapped on to the World Health Organisation International Classification of Functioning Disability and Health (ICF).
Source references
- Ashford S, Williams H, Nair A, Orridge S,Turner-Stokes L. Categorisation of goals set using Gola Attainment Scaling for treatment of leg spasticity: a multicentre analysis. Disability and Rehabilitation 2019; 41 (16) : 1925-1930 doi: 10.1080/09638288.2018.1451927.
The simplified, semi-structured approach to Goal Attainment scaling for use in clinical settings has assisted in facilitating further analysis of goals for specific target groups both in the UK and internationally.
- The Upper Limb International Spasticity (ULIS) programme is a large series of international cohort studies conducted in over 31 countries across 4 continents to examine real life practice in management of upper limb spasticity if real. GAS-light was used as the primary outcome measure within the series, which led on to the development and incorporation of the GASeous tool.
- A structured goal setting approach has also been developed in the context of prolonged disorder of consciousness.
- The impact of alternative approaches to goal rating has been explored.
Key publications
Turner-Stokes L, Rose H, Lakra C, Williams H, Ashford SA, Siegert RJ. Goal-setting and attainment in prolonged disorders of consciousness - development of a structured approach. Brain Inj. 2020;34(1):78-88. doi: 10.1080/02699052.2019.1682190.
Turner-Stokes L, Fheodoroff K, Jacinto J, Maisonobe P. Results from the Upper Limb International Spasticity Study-II (ULISII):a large, international, prospective cohort study investigating practice and goal attainment following treatment with botulinum toxin A in real-life clinical management. BMJ Open. 2013; 3(6):e002771. doi: 10.1136/bmjopen-2013-002771.
Turner-Stokes L, Fheodoroff K, Jacinto J, Maisonobe P, Zakine B. Upper limb international spasticity study: rationale and protocol for a large, international, multicentre prospective cohort study investigating management and goal attainment following treatment with botulinum toxin A in real-life clinical practice. BMJ Open. 2013 Mar 18;3(3):e002230. doi: 10.1136.
Turner-Stokes L, Jacinto J, Fheodoroff K, Brashear A, Maisonobe P, Lysandropoulos A, Ashford S. Longitudinal goal attainment with integrated upper limb spasticity management including repeat injections of botulinum toxin A: Findings from the prospective, observational Upper Limb International Spasticity (ULIS-III) cohort study. Journal Rehabilitation Medicine. 2021;53(2) doi: 10.2340/16501977-2801.
Turner-Stokes L, Jacinto J, Fheodoroff K, Brashear A, Maisonobe P, Lysandropoulos A, Ashford S; Upper Limb International Spasticity-III (ULIS-III) study group. Assessing the effectiveness of upper-limb spasticity management using a structured approach to goal-setting and outcome measurement: First cycle results from the ULIS-III Study. Journal of Rehabilitation Medicine. 2021; 53(1). doi: 10.2340/16501977-2770.
Turner-Stokes L, Baguley IJ, De Graaff S, Katrak P, Davies L, McCrory P, Hughes A. Goal attainment scaling in the evaluation of treatment of upper limb spasticity with botulinum toxin: a secondary analysis from a double-blind placebo-controlled randomized clinical trial. Journal of Rehabilitation Medicine. 2010 (1):81-9. doi: 10.2340/16501977-0474.
Turner-Stokes L, Williams H. Goal attainment scaling: a direct comparison of alternative rating methods. Clin Rehabil. 2010 Jan;24(1):66-73. doi: 10.1177/0269215509343846. Epub 2009 Dec 21. PMID: 20026573.
The original GAS is widely used in many settings in the UK and Internationally.
The GAS-light, GAS-eous and GAS-leg are used widely in busy neurorehabilitation settings in the UK and internationally, particularly in Australia, Portugal, France and Germany.