2004 - 2007 - Cicely Saunders Institute - King's College London

tasks. Some patients, especially early in the recovery
phase, may expect to regain voluntary control of their
arm and hand following relief of spasticity, but for more
severe and longer-standing paralysis, the goals for
intervention tend to be ‘passive function’ such as
improving the ease of caring for the person – for
example making it easier to maintain hygiene or to put
the arm through a sleeve while dressing. A systematic
review of the literature revealed no suitable tools
currently available for measuring both passive and active
functions of the upper limb that would properly assess
the functional benefits of managing upper limb
spasticity, so we have developed a new tool called the
ArMA, which is now undergoing evaluation.
Patient-centred outcomes in rehabilitation - the
use of Goal Attainment Scaling (GAS)
Goal attainment scaling (GAS) was first introduced in the
1960s as a tool for evaluating individualised outcomes in
complex interventions in patients with learning disabilities,
but it has only relatively recently gained popularity
outside in other fields. One of the major challenges for
outcome measurement in rehabilitation is the wide
variety of different goals that patients may have for their
rehabilitation programme. GAS absorbs much of this
variation within the process of goal setting, making it a
potentially valuable tool for this context. Moreover, a
patient-centred instrument that specifically evaluates the
outcomes that are important to the patient and their
family provides an important perspective that is not
included in most standardised measures of outcome.
In our preliminary application of GAS as a measure for
assessing focal changes during the management of
upper limb spasticity (see above) Ashford and Turner-
Stokes found that GAS provided a useful measure of
functional gains in response to treatment, and was more
sensitive than global measures such as the Barthel
Index 208 . Further work is underway to address the
benefits of GAS over currently applied standardised
outcome measures in our wider rehabilitation
programme.
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