Stolee P, Stadnyk K, Myers A M, Rockwood K
Southwestern Ontario Regional Geriatric Program, St. Joseph's Health Centre-Parkwood Site, London, Ontario, Canada.
J Gerontol A Biol Sci Med Sci. 1999 Dec;54(12):M641-7. doi: 10.1093/gerona/54.12.m641.
The heterogeneity of health problems experienced by frail elderly patients makes it difficult to use a single standard measure to evaluate multiple outcomes of geriatric rehabilitation. Commonly, several measures are used, but an alternative is to use an individualized measure such as Goal Attainment Scaling (GAS). This study investigated the reliability, validity, and responsiveness of GAS as an outcome measure in geriatric rehabilitation.
We studied 173 consecutive admissions (mean age 81; 77% female; mean length of stay 33 days) to a geriatric rehabilitation unit. Assessment instruments were completed at admission and discharge. Individualized treatment goals were identified for each patient by using GAS; standardized measures included self-rated health, a global clinical assessment, the Barthel Index, the OARS IADL scale, the Folstein Mini-Mental State Examination (MMSE), and the Nottingham Health Profile (NHP).
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 strongly (r> or =0.50) with the standardized measures, except for self-rated health, the MMSE, and the NHP (r> or =0.31). GAS was more responsive to change than any of the standardized measures. The GAS score was used to derive receiver operating characteristic curves for other measures; this can provide insight into the interpretation of clinically important outcomes.
GAS appears to be a feasible, reliable, valid, and responsive approach to outcome measurement in geriatric rehabilitation.
体弱老年患者所经历的健康问题具有异质性，这使得难以使用单一标准测量方法来评估老年康复的多个结果。通常会使用多种测量方法，但另一种选择是使用个性化测量方法，如目标达成量表（GAS）。本研究调查了GAS作为老年康复结果测量指标的可靠性、有效性和反应性。
我们研究了173例连续入住老年康复科的患者（平均年龄81岁；77%为女性；平均住院时间33天）。在入院和出院时完成评估工具。通过使用GAS为每位患者确定个性化治疗目标；标准化测量包括自评健康状况、整体临床评估、巴氏指数、OARS日常生活活动量表、福林简易精神状态检查表（MMSE）和诺丁汉健康概况（NHP）。
活动能力、未来护理安排和功能障碍是最常确定的GAS目标领域。GAS出院评分的评分者间信度为0.93。GAS出院评分与标准化测量指标（自评健康状况、MMSE和NHP除外，r≥0.31）的相关性很强（r≥0.50）。GAS对变化的反应比任何标准化测量指标都更敏感。GAS评分用于推导其他测量指标的受试者工作特征曲线；这有助于深入理解对临床重要结果的解释。
GAS似乎是一种可行、可靠、有效且对老年康复结果测量有反应的方法。
