The practical use of goal attainment scaling for people with acquired brain injury who receive cognitive rehabilitation

Abstract

Objective: To examine the feasibility of and clinical experiences with goal attainment scaling when used for the evaluation of cognitive rehabilitation in people with acquired brain injury. Design: A prospective observational longitudinal study. Setting: A 21-week cognitive rehabilitation programme and a cognitive programme with varying length in two different Dutch rehabilitation centres. Subjects: Forty-eight consecutive patients with acquired brain injury enrolled during a 15-month period. Interventions: Cognitive rehabilitation programme. Main measure: Goal attainment scaling; the number of goals was counted; time to set goals was recorded; the number of different domains in which goals were set was counted; goal attainment scaling score was calculated at baseline, one week after the end of the cognitive rehabilitation programme and at six months follow-up; clinical experiences that could be useful for both clinical and research practice were recorded. Results: The mean (SD) age of the patients was 46.1 (10.7) years; 29 (60%) were male; 186 goals were set with a mean (SD) number of 4 (1) goals per patient. It was possible to set at least three realistic goals per patient within 30 minutes. Most goals were set in the cognitive domain (i.e. memory and attention), followed by the behavioural domain (i.e. fatigue and aggression). Conclusion: It proved possible to set three goals within an acceptable time-frame, to involve patients in the goal-setting procedure, to set realistic goals, and to set goals within relevant domains. Based on clinical experiences, goal attainment scaling is less feasible for research when patients lack insight, or suffer from comorbidity or mood problems.