Table IV.

Additional reflections on goal attainment scaling (GAS)

GAS, eHealth and Apps	Apps to easily write GAS (GOALed) (83) Apps for calculating GAS T-scores (83) Apps integrating motivational interviewing in GAS process (84) Apps encouraging interprofessional care in community based-settings (93)
Positive and negative aspects	See supplemental material Table SIII. Negative and positive aspects of application of GAS, to help reflect on these aspects, especially before use of GAS as an outcome measure
Statistical aspects	Recommendations and precautions regarding statistical interpretation of GAS results (2, 30, 55, 94)
GAS with cognitive impairment	Using GAS with cognitive impairment: is essential even if intervention is not aimed at cognitive impairment (e.g. spasticity management after stroke), as associated cognitive comorbidities impact GAS management, from selecting realistic goals, to retaining, and implementing them. Cognitive abilities impact directly on goal achievement when functional performance is involved (98). Remembering personal goals and implementing them is particularly difficult for individuals with cognitive impairment (96, 97): deficits in executive function and memory can make it difficult to spontaneously plan, formulate and monitor progress towards goals. Difficulties with emotional regulation and cognitive impairment will also impact a person’s ability to feel a sense of energy or drive towards achieving goals. Aphasia and cognitive limitations may discourage therapist use of GAS, even if relevant and valuable (98–100), given that basic language (e.g. 2–3 word verbal cues) and non-verbal communication (e.g. gestures, sign language) can be used (43). Unfortunately, research exploring motor function interventions with GAS (e.g. in stroke), does not address cognitive limitations that impede goal retention, implementation and commitment. The use of meta-cognitive and/or behavioural rehabilitation approaches for patients with cognitive and/or behavioural impairments seems to be an interesting option to support the achievement of GAS goals (38, 67, 80, 82, 101).
Goal-focused rehabilitation	Implementation of GAS in routine clinical practice is not just about introducing personalized outcome-measures. It also provides a framework for patient/caregiver collaboration and engagement toward goal achievement through patient-centred rehabilitation. Planning of rehabilitation should be conducted according to patient priorities and follow-up meetings to provide individualized therapy based on patient goals. GAS implementation across clinical rehabilitation teams can rely on goal focused rehabilitation frameworks, i.e. using GAS as a mean to think about and plan personalized treatment (71, 72, 102, 103).