Authors (including presenting author) :
CHAN TS(1), HO WH(1), LEE WL(1), CHAN YK(1), CHE PSP(1), LI HY(1), MAK PKF(1), KNG PLC(1)
Affiliation :
(1) Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals
Introduction :
Goal-setting with patient engagement is an essential element for stroke rehabilitation, increasing patient motivation by active empowerment, facilitating communication and managing expectations for realistic outcomes. Rehabilitation measures such as Barthel index usually reported by multidisciplinary rehabilitation team do not incorporate the patient’s voice in setting goals of value and meaning from patient’s perspectives.
Objectives :
This study explored the use of Goal Attainment Scale (GAS) as a person-centred outcome measure in stroke rehabilitation, and the relationship of GAS to other conventional rehabilitation outcome measures.
Methodology :
All stroke patients admitted to male stroke rehabilitation unit (SRU) from May 2019 to May 2020 were recruited. Individualised goal setting together with patient and family was facilitated at the initial multidisciplinary team (MDT) conference to obtain admission GAS score. Weekly review of goals during the rehabilitation process and a discharge GAS score rated by MDT was done upon discharge from SRU. Baseline and final GAS score with other outcome measures such as Barthel index (BI) and Modified Functional Ambulation Category (MFAC) were analysed.
Result & Outcome :
49 male patients with mean age 68.84 were recruited. 65.3% were ischemic stroke and 34.7% were haemorrhagic stroke. Person-set goals were divided into 3 categories: improvement in ADL function(34.7%), improvement in mobility(59.2%) and improvement in speech functioning(6.1%). Mean GAS at admission was 38.2 which improved significantly to 52.2(z=-5.861, p< 0.001) at discharge. 43 out of 49 patients(87.8%) had thier goals achieved at discharge. Gain in GAS score was congruent with improvement in BI(z=-5.498, p< 0.001) and MFAC(z=-4.287, p< 0.001).
GAS provides SRU as a practical means to put patient engagement as central and enable person-centred care to be measurable. Significant positive outcomes in GAS corresponded with other rehabilitation outcome measurements. Its added advantages are its simplicity and value in increasing patient satisfaction and motivation in their own rehabilitation, using a common language which can be shared and understood by patients and families and MDT.
