Individualised outcome measures and goals: a momentary detour

Just taking a tiny detour from our journey through goals and use of goals in pain management today, to take a quick look at a couple of ways of measuring progress in pain management that can help personalise the outcomes.

The first is a likert-type scale from 0 – 10 (or any number, really), where the anchors relate to goal performance. Take a specific functional goal (for example, to hang out a whole load of washing). Make sure it’s a specific, measurable goal!

The degree to which the person can manage that goal at time 1 is then equal to zero, and becomes the least anchor. The degree to which the person wants to achieve the goal is then equal to 10, or the end point.

Each time the person’s level of achievement is measured it is then recorded against the scale, with an objective measure of their achievement. It doesn’t really matter what scale is used, or whether each step along that scale is equal, it’s the person’s own rating of their progress from 0 – 10 that is recorded, along with the actual physical measurement at that point. For example, a ‘5’ might be that the person can hang out 10 pairs of socks, while the next measure could be ‘8’ for hanging out the 10 towels.  You can add to this a set of likert-type scales for ‘importance’, ‘confidence’ and ‘satisfaction’, to extend the usefulness of the measure.

Another version of goal recording is the Goal Attainment Scale. This was first developed for use in mental health settings where behavioural goals can be quite complex. Criterion-referenced goals are set, and have a 5-point ordinal scale of achievement with 2 levels above and 2 below the desired goal.

What this means is the person can achieve extremely well, scoring +2, or not achieve well at all, and score -2, or points in between. There is quite a literature about GAS, including some on its use in pain management settings.

And of course, the final one has to be the Canadian Occupational Performance Measure. The drawback to this is that it is reserved for occupational therapists, although the basic methodology isn’t so distinctively ‘occupational therapy’ that other professions couldn’t adopt it.

Basically this is a semi-structured interview process that asks the person to consider activities within the three main domains of occupational performance – work, self care and leisure – and after ranking their most important activities, asks them to rate the importance and satisfaction with their performance before treatment on a scale of 0 – 10. At the end of treatment, the person re-rates their performance goals, and the score provides a way of measuring outcome. Again like the GAS, there is a lot of literature on its use, including its use in pain management.

So, there you have it – three ways of individualising outcomes to suit the specific goals of individuals that capture some of the special things that people want to achieve rather than trying to fit all of the functional goals into things like the FIM or Oswestry.

Carpenter L, Baker GA, Tyldesley B. (2001). The use of the Canadian occupational performance measure as an outcome of a pain management program. Canadian Journal of Occupational Therapy, 68(1):16-22.

Fairbank J, Davies J, Couper J, OBrien J (1980) The Oswestry low back pain disability questionnaire Physiotherapy 66, 8, 271-273

Fisher K, Hardie R J. (2002). Goal attainment scaling in evaluating a multidisciplinary pain management programme. Clinical Rehabilitation, (16) 8, 871-877

Heavlin WD, Lee-Merrow SW, Lewis VM (1982) The psychometric foundations of goal attainment scaling Community Mental Health Journal 18, 230-241

Kiresuk T, Sherman R (1968) Goal Attainment Scaling: a general measure of evaluating comprehensive mental health programs Community Mental Health Journal 4, 443-453

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