Rockwood Kenneth, Howlett Susan, Stadnyk Karen, Carver Daniel, Powell Colin, Stolee Paul
Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
J Clin Epidemiol. 2003 Aug;56(8):736-43. doi: 10.1016/s0895-4356(03)00132-x.
Frail elderly patients have complex problems that require a multidimensional assessment and a range of treatment goals. Goal Attainment Scaling (GAS) measures multiple, individualized goals, but its responsiveness in comparative clinical trials has not been established.
We assessed the responsiveness of GAS in a randomized, controlled trial of an interdisciplinary Mobile Geriatric Assessment Team (MGAT) in 265 rural frail older adults. Sensitivity to change was compared with standard measures; clinical meaningfulness was assessed in relation to a patient and a blinded physician global measure.
At 3 months follow-up, GAS was the most responsive measure (standardized response mean 1.22, Norman's responsiveness statistic 0.58) compared with the Barthel Index (1.13, 0.46), Physical Self-Maintenance Scale (0.10, 0.16, 0.02), Instrumental Activities of Daily Living (0.23, 0.00), and modified Spitzer Quality of Life Index (-0.04, 0.00).
Only GAS detected clinically important change associated with the MGAT intervention in these frail elderly patients. Clinometric measures can offer a responsive means of evaluating complex interventions.
体弱的老年患者存在复杂问题，需要进行多维度评估并设定一系列治疗目标。目标达成量表（GAS）可衡量多个个体化目标，但其在比较性临床试验中的反应性尚未得到证实。
我们在一项针对265名农村体弱老年人的跨学科移动老年评估团队（MGAT）的随机对照试验中评估了GAS的反应性。将其对变化的敏感性与标准测量方法进行比较；根据患者和一位不知情的医生的整体评估来评估临床意义。
在3个月的随访中，与巴氏指数（标准化反应均值1.13，诺曼反应性统计量0.46）、身体自我维持量表（0.10，0.16，0.02）、日常生活工具性活动（0.23，0.00）以及改良的斯皮策生活质量指数（-0.04，0.00）相比，GAS是反应性最强的测量方法（标准化反应均值1.22，诺曼反应性统计量0.58）。
在这些体弱老年患者中，只有GAS检测到了与MGAT干预相关的具有临床意义的变化。临床测量方法可为评估复杂干预措施提供一种反应灵敏的手段。
