Goal attainment scaling in paediatric rehabilitation: a critical review of the literature

Steenbeek, Duco; Ketelaar, Marjolijn; Galama, Krys; Gorter, Jan Willem

doi:10.1111/j.1469-8749.2007.00550.x

Cited by 188 publications

(142 citation statements)

References 30 publications

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“…To date, this approach has predominantly been confined to adult rehabilitation, 57 although its use in paediatrics has been critically evaluated. 58 This latter piece of work called for more research into the reliability of goal attainment scaling within the paediatric context. A useful piece of work going forward would be to review evidence on this.…”

Section: Participation As An Outcome Measurementioning

confidence: 99%

Therapy interventions for children with neurodisabilities: a qualitative scoping study

Beresford

Clarke

Maddison

2018

Health Technol Assess

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Background Therapy interventions emerged four times in the top 10 research priorities in a James Lind Alliance research prioritisation exercise for children with neurodisabilities (Morris C, Simkiss D, Busk M, Morris M, Allard A, Denness J, et al. Setting research priorities to improve the health of children and young people with neurodisability: a British Academy of Childhood Disability-James Lind Alliance Research Priority Setting Partnership. BMJ Open 2015;5:e006233). The National Institute for Health Research (NIHR) commissioned this study as part of an information-gathering exercise in response to this. Objectives The objectives were to (1) describe the current practice, approaches and schools of thought in relation to physiotherapy, occupational therapy and speech and language therapy for children with neurodisability; (2) explore clinical decision-making; (3) investigate views on outcomes and their measurement, particularly participation as an outcome, that is, the child’s ability to have the opportunity to be involved in life situations and activities (e.g. communication, mobility, interpersonal interactions, self-care, learning and applying knowledge); (4) seek views on the aspects of therapy interventions that have an impact on outcomes; and (5) elicit stakeholder views on research needs and priorities. Design, setting and participants More than 70 professionals (therapists, service leads, paediatricians and education staff) and 25 parents participated in a qualitative interview (either individually or as part of a focus group). Results Professional thinking and models of service delivery are in a state of flux and development. There is a move towards goals-focused, family-centred approaches. Work tends to be highly individualised, with few protocols. Parents are certain of the value of therapies, although they may experience difficulties with provision and may seek (additional) private provision. Therapy interventions are conceived as three components: the therapist, the procedures/equipment, etc., and the wider therapeutic environment. They are believed to be highly complex and poorly understood. Although participation is widely endorsed as a core intervention objective of therapy interventions, its suitability, or appropriateness, as an outcome measure was questioned. Other child and/or parent outcomes were identified as more or equally important. Notions of intermediate outcomes – in terms of body structure/function, and the achievement of activities – were regarded as important and not counter to participation-focused approaches. Among therapists, research on intervention effectiveness was (cautiously) welcomed. A number of methodological challenges were identified. A portfolio of study designs – quantitative and qualitative, experimental and observational – was called for, and which included economic evaluation and clear pathways to impact. Limitations The study was not successful in recruiting children and young people. Further work is required to elucidate the views of this key stakeholder group. Conclusions Therapy interventions are poorly understood. There was strong support, tempered a little by concerns among some about the feasibility of demonstrating impact, for investment in research. Future work The identification of research priorities was a core study objective, and a wide-ranging research agenda was identified. It included ‘foundational’ research into neurodisability, the active components of therapy interventions and the concept of participation. Three areas of evaluation were identified: overall approaches to therapy, service organisation and delivery issues, and the evaluation of specific techniques. Parents regarded evaluations of approaches to therapy (e.g. goals-focused; supporting family-self management) as priorities, along with evaluations of models of service provision. Professionals’ views were broadly similar, with an additional emphasis on methodological research. In terms of specific techniques, there was no shared agreement regarding priorities, with views informed by personal interests and experiences. Funding The NIHR Health Technology Assessment programme.

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Section: Participation As An Outcome Measurementioning

confidence: 99%

Therapy interventions for children with neurodisabilities: a qualitative scoping study

Beresford

Clarke

Maddison

2018

Health Technol Assess

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“…30 The Melbourne aims to assess the quality of upper limb movements in children with neurological impairment in the age range of 5 to 15 years. The modified Melbourne Assessment of Unilateral Upper Limb Function 31 for children in the age range of 2 to 5 years has recently been developed.…”

Section: Outcome Assessmentsmentioning

confidence: 99%

Effectiveness of Modified Constraint-Induced Movement Therapy in Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial

Aarts

Jongerius

Geerdink

et al. 2010

Neurorehabil Neural Repair

154

189

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Background. In children with unilateral spastic cerebral palsy (CP), there is only limited evidence for the effectiveness of modified constraint-induced movement therapy (mCIMT). Objective. To investigate whether 6 weeks of mCIMT followed by 2 weeks of bimanual task-specific training (mCIMT-BiT) in children with unilateral spastic CP improves the spontaneous use of the affected limb in both qualitative and quantitative terms more than usual care (UC) of the same duration. Methods. Children with unilateral spastic CP with Manual Ability Classification System (MACS) scores I, II, or III and aged 2.5 to 8 years were recruited and randomly allocated to either the mCIMT-BiT group (three 3-hour sessions per week: 6 weeks of mCIMT, followed by 2 weeks of task-specific training in goal-directed bimanual play and self-care activities) or to 1.5 hours of more general physical or occupational weekly plus encouragement to use the affected hand for the UC group. Primary outcome measures were the Assisting Hand Assessment and the ABILHAND-Kids. Secondary outcomes were the Melbourne Assessment of Unilateral Upper Limb Function, the Canadian Occupational Performance Measure, and the Goal Attainment Scale. Results. Twenty-eight children were allocated to mCIMT-BiT and 24 to UC. Except for the Melbourne, all primary and secondary outcome measures demonstrated significant improvements in the mCIMT-BiT group. Conclusion. mCIMT followed by task-specific training of goal-directed bimanual play and self-care activities is an effective intervention to improve the spontaneous use of the more affected upper limb in children with relatively good baseline upper extremity function.

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“…Similar to these studies Steenbeek et al, 2007), we found that GAS was responsive and sensitive to incremental change amongst children. It is difficult to compare our study with previous research in relation to the combination of the model of intervention we used and our primary outcome measure.…”

Section: Discussionsupporting

confidence: 75%

“…There is evidence supporting the use of GAS in the paediatric rehabilitation setting (Steenbeek et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Physiotherapy intervention for 4-5 year old children born extremely preterm and/or extremely low birth weight

Brown¹

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Neurodevelopmental impairments amongst the extremely low birth weight (ELBW) or extremely preterm population are well recognised. However, support services for these children who have mild impairments are lacking. This research aimed to explore the performance of a group of non-disabled ELBW or extremely preterm children with minimal/mild impairments over a 12 month period at a critical time-point, coinciding with the commencement of formal education. Performance of these children was established, as well as whether impairments persist. Persistence of impairments may suggest a widening gap between performance of these children and expected performance of term born peers. Additionally, this research aimed to investigate the short term and longer term impact of group-based physiotherapy intervention compared to standard care. SubjectsFifty children born ELBW and/or extremely preterm (26 males; mean birth weight: 838.8g, SD 174.8g; mean gestational age: 27.0 weeks, SD 2.0 weeks) with minimal/mild motor impairments and a mean age (corrected for prematurity) of 50 months (SD 2.6 months) at baseline. Twenty-four children were randomised to intervention and 26 children to standard care. MethodsChildren were assessed by paediatric physiotherapists blinded to group allocation. A set testing protocol was used. Baseline assessment included: Movement Assessment Battery for Children second-edition (MABC-2), tests of postural stability and limb strength, Child Behavior Checklist (CBCL) and Beery Visual-Motor Integration Test 5 th Edition (Beery VMI). Following baseline assessment, children were randomly allocated to intervention or standard care. All children were assessed on motor and postural tests at the conclusion of the intervention. Goal Attainment Scaling (GAS) was utilised within the intervention group. At one year post baseline assessment, all children were assessed on baseline tests, as well as Peabody Picture Vocabulary Test 4 th Edition (PPVT-4). The group had low average motor co-ordination, lower than expected postural stability and strength, and acceptable behaviour. Mean percentile rank on MABC-2 was 31%.However, 30% of children had a score less than or equal to the 15 th percentile, indicating at risk of or having a definite motor problem and these children had poorer postural outcomes compared to children with normal motor performance. Behaviour was within normal range according to performance on CBCL, although between 11-15% of children had a score within the clinical range. Behaviour of males was poorer than that of females. Study IV: GAS to explore effect of group-based physiotherapy intervention on personal growth of non-disabled ELBW children Intervention was effective with GAS mean T score of the group exceeding the expected level (mean=58.17, SD=0.82). Goal attainment was associated with motor co-ordination 4 and children with better motor skills post intervention, were more successful in reaching goals. Females improved more than males on GAS. Study V: Behaviour of 4-5 year old non-disabled E...

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Goal attainment scaling in paediatric rehabilitation: a critical review of the literature

Cited by 188 publications

References 30 publications

Therapy interventions for children with neurodisabilities: a qualitative scoping study

Therapy interventions for children with neurodisabilities: a qualitative scoping study

Effectiveness of Modified Constraint-Induced Movement Therapy in Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial

Physiotherapy intervention for 4-5 year old children born extremely preterm and/or extremely low birth weight

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