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Goal attainment scale for ambulatory children with cerebral palsy:with and without orthopedic surgery

Walter E & Agnes M Griffin Motion Analysis Lab, Shriners Hospitals for Children, Spokane, WA, USA

Background/Objectives: The purpose of this study was to use the goal attainment scale (GAS) for assessing the outcomes of specific goals of children with cerebral palsy (CP) following lower extremity orthopedic surgery or following a period of time without orthopedic surgery. The GAS is used to address the specificity and subtleties of improvement or decline ofter missed by standardized questionnaires such as the PODCI.

Design: Retrospective control study.

Participants and Setting: Sample of convenience from a Children’s Hospital-Motion Analysis Lab (MAL). Twenty-seven subjects (mean age 12.1; GMFCS Level I=14, II=11; III=2) established goals pre-operatively and rated achievement of those goals following surgery at their post-operative MAL visit. Thirteen subjects (mean age 11.4; GMFCS Level I=5; II=7; III=1) established goals during a visit to the MAL and rated achievement of those goals at a follow up visit to the MAL with no surgery in between. Achievement of goals was based on a five point scale (-2 to +2) with `0’ being `met the goal’.

Materials/Methods: A questionnaire asking the parent to establish their `top 3 goals’ for their child’s mobility has been administered since 2006 for all subjects as part of their routine MAL study. Goals were established by the parent without a provider’s input regarding the appropriateness or `achievability’ of the goals. The goal attainment scale ratings at the second visit were converted to a T score. When the goals are met, the T score is 50; not meeting a goal will result in a score less than 50; exceeding a goal will result in a score greater than 50.

Results: In the surgical group (Sx group), the T scores were equiv alent to 50 (77 goals; 33% `not met’ or `decreased’). In the non-surgical group (NonSx group), the T scores were significantly less than 50 (36 goals; 86% `not met’ or `decreased’). Significant improvements were noted in the Sx group on the PODCI in several categories while no significance was found for the NonSx group in any category. Significant improvement was found on the Gait Deviation Index for the Sx group but not for the NonSx group. The Gillette FAQ did not change for either group. Statistical analysis for different GMFCS levels was not possible due to the small sample size.

Conclusions/Significance: Children with cerebral palsy who had lower extremity surgery met their goals while those that did not have surgery did not meet their goals. However, 15 out of 27 subjects in the Sx group had at least one goal that was `not met’. No advisement about the viability of the goals was provided when the goals were recorded. If a professional guided the family in setting goals, it may improve compatibility of expectations for treatment while retaining the uniqueness of the goals for the child. Subtleties of change that may be elucidated by the GAS when completed by the family following treatment could demonstrate truer representations of the outcomes. In conclusion, the goal attainment scale provides a focused assessment of outcomes following orthopedic surgery and can be used as an adjunct to other standard tools.

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