Finding a clinical assessment scale - Physical Medicine and Rehabilitation

échelles d'évaluations cliniques - GAS

Goal Attainment Scaling GAS scale - What is it?

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GAS scale:

 What is it? ^ top of page

HISTORY:

  - Described for the first time in the 1960's

      . To evaluate learning capacity (1)

  - Now applied in numerous fields of rehabilitation :

      . Geriatric rehabilitation (2,3)
      . Chronic pain (4)
      . Cognitive rehabilitation (5)
      . Rehabilitation of amputees (6)
      . Neurological rehabilitation (7)
      . Spasticity management (8)


WHAT IS THE GAS SCALE?

  - The GAS scores evaluates the degree of success

      . in achieving the objectives of a rehabilitation programme

  - Each item is derived from personalized objectives established a priori with the patient

  - The attainment of the objectives is established

      . on a discrete scale,
      . in order to calculate a standardized score


WHY USE THE GAS SCALE?

  - Avoids the inconveniences associated with generic measurements scales:

      . Floor and ceiling effects
      . Lack of sensitivity (particularly global measurements)

  - Defines objectives

  - Encourages communication and evaluation of the treatment objectives within the rehabilitation team

  - Encourages participation of the patient and care staff:

      . Objectives are more likely to be achieved if the patients participate in their establishment (4)

  - There is increasing evidence to show that:

      . The GAS scale is more sensitive than other outcome measures to detect the changes relating
        to personalized objectives (7, 9, 10)

  - It is the only scale that evaluates treatment efficacy in heterogeneous patient groups and objectives


CHARACTERISTICS OF THE GAS SCALE

  - Requires the establishment of clear objectives for a given intervention

  - Specifically measures the elements which the intervention is intended to change

      . for example body functions and structure, activities and participation

  - - Helps to orientate and plan the treatment


THE GAS SCALE IS A DIFFERENT CONCEPT FROM CLASSIC SCALES

  - It is not a performance measurement:

      . It measures the achievement of objectives

  - It depends on two elements:

      . The capacity of the patient to change

      . The capacity of the team to predict a result

  - It is reasonable to expect that clinicians

      . have an idea of the probable result of the intervention they propose in order to balance the benefits
       and potiential risks.


EXAMPLES OF JOINT OBJECTIVES IN SPASTICITY

  - Passive function and reduction of contractures:

      . To facilitate hygiene of the arm/hand, e.g.: washing under the arm, cutting nails

      . To facilitate mobilization / fitting of a splint

  - Pain:

      . To reduce spasticity-related pain

  - Involuntary movements:

      . To reduce associated reactions

  - Active performance:

      . To improve use of the arm and hand to grasp or carry objects


HOW TO USE THE GAS SCALE: 3 SIMPLE STAGES

  - Stage 1 :

      . Establishment of the objectives

  - Stage 2 :

      . Evaluation of achievement of objectives
        (Everything the clinicians need to know)

  - Stage 3 :

      . Weighting of importance
        (Optional)


(1) Kiresuk T, et al. Comm Mental Health J 1968; 4: 443-453.
(2) Stolee P, et al. J Am Geriatr Soc 1992; 40(6): 574-578.
(3) Stolee P, et al. J Aging Health 1999; 11(1): 96-124.
(4) Williams RC, et al. Clin J Pain 1987; 2: 219-228.
(5) Rockwood K, et al. J Clin Epidemiol 1997; 50(5): 581-588.

(6) Rushton PW, et al. Arch Phys Med Rehabil 2002; 83(6): 771-775.
(7) Turner-Stokes L, et al. Journal of Rehabilitation Medicine 2009 - e.pub ahead of print.
(8) Ashford S, et al. Physiotherapy Res Int 2006; 11: 14-23.
(9) Rockwood K et al. J Clin Clinical Epidemiol 1993; 46(10): 1113-1118.
(10) Gordon JE et al. Age Ageing 1999; 28(3): 275-281.

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