Journal of Clinical Epidemiology 56 (2003) 736–743 Responsiveness of goal attainment scaling in a randomized controlled trial of comprehensive geriatric assessment Kenneth Rockwood a, * , Susan Howlett b , Karen Stadnyk a , Daniel Carver a , Colin Powell a , Paul Stolee a,c a Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada b Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada c Southwestern Ontario Regional Geriatric Program, London, Ontario, Canada Accepted 9 April 2003 Abstract Background and Objective: Frail elderly patients have complex problems that require a multidimensional assessment and a range of treatment goals. Goal Attainment Scaling (GAS) measures multiple, individualized goals, but its responsiveness in comparative clinical trials has not been established. Methods: We assessed the responsiveness of GAS in a randomized, controlled trial of an interdisciplinary Mobile Geriatric Assessment Team (MGAT) in 265 rural frail older adults. Sensitivity to change was compared with standard measures; clinical meaningfulness was assessed in relation to a patient and a blinded physician global measure. Results: At 3 months follow-up, GAS was the most responsive measure (standardized response mean 1.22, Norman’s responsiveness statistic 0.58) compared with the Barthel Index (1.13, 0.46), Physical Self-Maintenance Scale (0.10, 0.16, 0.02), Instrumental Activities of Daily Living (0.23, 0.00), and modified Spitzer Quality of Life Index (-0.04, 0.00). Conclusions: Only GAS detected clinically important change associated with the MGAT intervention in these frail elderly patients. Clinometric measures can offer a responsive means of evaluating complex interventions.  2003 Elsevier Inc. All rights reserved. Keywords: Goal attainment scaling; Responsiveness; Elderly; Randomized controlled trial; Comprehensive geriatric assessment; Specialized geriatric intervention 1. Introduction The systematic evaluation of specialized geriatric pro- grams faces challenges that arise from the nature of the patients being served. These patients are typically frail, have multiple problems, and vary in what they need and expect of treatment [1]. Programs usually respond to this heterogeneity by offering a range of services such as medi- cine, nursing, social work, and physiotherapy, delivered by multidisciplinary teams. In contrast to these programs’ many interventions, their evaluation tends to focus on a limited number of outcomes [2,3]. The choice of outcomes is usually constrained by tradition, availability, and feasibility. Consequently, the usual choice yields only about two pri- mary outcomes, which typically have been developed using a psychometric, rather than a clinometric, approach [4]. * Corresponding author. Centre for Health Care of the Elderly, Queen Elizabeth II Health Sciences Centre Geriatric Medicine Research Unit, Room 1421, 5955 Jubilee Road, Halifax, Nova Scotia, Canada, B3H 2E1. Tel.: 902-473-8687; fax: 902-473-1050. E-mail address: rockwood@is.dal.ca (K. Rockwood). 0895-4356/03/$ – see front matter  2003 Elsevier Inc. All rights reserved. doi: 10.1016/S0895-4356(03)00132-X Despite the theoretical advantages of clinical relevance and patient-centeredness, clinometric measures have been used much less than psychometric ones [5]. In earlier studies, we tested the feasibility, validity, reliability, and respon- siveness of one clinometric measure, Goal Attainment Scal- ing (GAS), in frail elderly patients [4,6,7]. These tests supported the use of GAS and, in particular, its markedly greater responsiveness compared with measures using a psychometric paradigm. We further tested GAS by cross- validating it in patients with dementia [8–10] and in pa- tients with traumatic brain injury [11]. Such patients, who have many goals with varying levels of achievement being judged successful, share important attributes with frail el- derly persons. Because of its responsiveness, GAS may be useful in evaluative studies of frail older adults. On these grounds, and because in our experience GAS is a useful patient management tool, we chose GAS as the primary outcome measure in an evaluation of a specialized geriatric interven- tion, known as the Mobile Geriatric Assessment Team (MGAT), targeted at frail, community-dwelling, older adults.