Goal attainment scaling in evaluating a multidisciplinary pain management programme

OBJECTIVE: To examine the value of Goal Attainment Scaling (GAS) as a therapeutic tool and an outcome measure in a rehabilitation programme in the management of chronic pain. DESIGN: A prospective observational study. SETTING: A 15-day pain management programme, day case or residential, in an NHS Regional rehabilitation centre. SUBJECTS: One hundred and forty-nine consecutive patients enrolled during a 15-month period. INTERVENTIONS: Multidisciplinary structured educational programme of physiotherapy, occupational therapy and clinical psychology. MAIN OUTCOME MEASURES: GAS; timed tests of physical mobility measures; McGill Pain Questionnaire (MPQ); Pain Intensity Numerical Rating Scale (NRS); Oswestry low back pain Disability Questionnaire (ODQ); General Health Questionnaire (GHQ); Pain and Impairment Relationship Scale (PAIRS). GAS and physiotherapy measures were compared with baseline data at enrollment and at discharge 15 days later. At six-month follow-up all measures were repeated. RESULTS: Significant improvements at discharge were found for GAS, and physiotherapy measures. One hundred and twelve patients returned for review at six months, when improvements were maintained for GAS, sit/stand, Pain, ODQ and GHQ. GAS was shown to be a valid measure of ability, correlating significantly with walking improvement and somewhat less with a therapist-defined measure, suggesting some ability to discriminate. CONCLUSIONS: The improvement measured by GAS showed that patients were enabled by the programme to achieve personally valued goals over a six-month period and to improve on these more than on other more conventional outcome measures.