Outcomes of a multimodal cognitive and physical rehabilitation program for persons with mild dementia and their caregivers: a goal-oriented approach

Figures & data

Table 1 Goal attainment scaling formula and sample of goal setting

$T=50+\frac{10\mathrm{\Sigma }{w}_i{x}_i}{\sqrt{(1-\rho )\mathrm{\Sigma }{w}_j^2+\rho {\left(\mathrm{\Sigma }{w}_i\right)}^2}}$
Where xi represents the attainment score for each goal (a value from −2 to +2), and wi represents the weight assigned to a particular goal. As goals in this study were unweighted, wi =1. ρ-value reflects the expected correlation of attainment scores, which is assumed to be 0.30. In practice, the GAS T-score can be directly obtained from a summary score conversion table,a doing away with the need for manual calculations
Domain	Current	Goal	8-week review
Cognition (reality orientation with cues, eg, clocks, calendar)
Self-initiated reality orientation >1 time daily (+2)
Self-initiated reality orientation 1 time daily (+1)
Caregiver-initiated reality orientation >1 time daily (0)		✓	✓
Caregiver-initiated reality orientation 1 time daily (−1)
Not oriented, no reality orientation (−2)	✓
Carer stress
No carer stress (+2)
Very occasional, <1 time a month (+1)			✓
Minimal stress (0)		✓
Moderate stress (−1)	✓
Extreme stress, not coping (−2)
Engagement in leisure activities (watercolor painting and Chinese calligraphy)
Leisure activities for 30 minutes daily (+2)
Leisure activities for 30 minutes >3 times a week (+1)			✓
Leisure activities for 15 minutes >3 times a week (0)		✓
Leisure activities for 15 minutes <3 times a week (−1)	✓
No initiation of activities (−2)
Sleep
Sleep 6–8 hours a night (+2)
Sleep 4–5 hours a night (+1)
Sleep 2–3 hours a night (0)		✓
Sleep less than 2 hours a night (−1)	✓		✓
No sleep (−2)

Note:

a Data from Kiresuk et al.⁹

Abbreviation: GAS, goal attainment scaling.

Table 2 Participant baseline characteristics (n=55)

Characteristic	Value
Age, mean ± SD	79.2±6.3
Female, n (%)	25 (46)
Years of education, mean ± SD	9±5
Cognitive enhancers for dementia, n (%)	38 (69)
Etiology of dementia, n (%)
Alzheimer’s disease	36 (65)
Vascular dementia	7 (13)
Others	12 (22)
Median scores (interquartile range)
CMMSE	18 (15–21)
Barthel Index	100 (95–100)
IADL	11 (7–15)
EQ-5D	5 (5–5)
NPI-Q severity	2 (1–4)
NPI-Q caregiver distress	1 (0–3)
ZBI	16 (9–29)

Abbreviations: SD, standard deviation; CMMSE, Chinese Mini-Mental State Examination; IADL, Instrumental Activities of Daily Living; EQ-5D, EuroQoL-five dimension questionnaire; NPI-Q, Neuropsychiatric Inventory Questionnaire; ZBI, Zarit Burden Interview.

Figure 1 Types and number of goals met or unmet.

Table 3 Comparison of scores pre- and postintervention, with effect size estimates for each measure

Measure	Preintervention	Postintervention	P-value	Effect size
GASa	36.8 (1.0)	48.6 (6.5)	<0.001	2.53
CMMSEb	18.0 (15.0–21.0)	19.0 (15.8–21.3)	0.14	0.14
Barthel Index	100 (95–100)	100 (95–100)	0.60	0.05
IADL	11 (7–15)	12 (8–14)	0.24	0.11
EQ-5D	5 (5–5)	5 (5–5)	–	–
ZBI total	16 (9–29)	14 (6–26)	0.080	−0.17
Factor 1 (demands of care and social impact)	8 (4–16)	7 (2–7)	0.046	–
Factor 2 (confidence or control over the situation)	1 (1–5)	0 (0–2)	0.004	–
Factor 3 (psychological impact on caregiver)	3 (1–7)	2.5 (0–6.25)	0.068	–
Factor 4 (worry about caregiving performance)	3 (2–4)	3 (2–4)	0.899	–
NPI-Q severity	2 (1–4)	1 (0–3)	0.24	−0.11

Notes:

a Mean (±SD) for GAS scores.

b Median (IQR) for CMMSE, Barthel, IADL, EQ-5D, Zarit, and NPI-Q severity scores.

Abbreviations: GAS, goal attainment scaling; CMMSE, Chinese Mini-Mental State Examination; IADL, Instrumental Activities of Daily Living; EQ-5D, EuroQoL-five dimension questionnaire; NPI-Q, Neuropsychiatric Inventory Questionnaire; ZBI, Zarit Burden Interview; IQR, interquartile range; SD, standard deviation.

Table 4 Spearman correlation coefficients for change scores and GAS scores

Change score	Correlation coefficient	P-value
Barthel Index	−0.155	0.281
IADL	−0.089	0.540
EQ-5D	−0.179	0.214
NPI-Q severity score	−0.461	0.001
ZBI	−0.352	0.013

Abbreviations: IADL, Instrumental Activities of Daily Living; EQ-5D, EuroQoL-five dimension questionnaire; NPI-Q, Neuropsychiatric Inventory Questionnaire; ZBI, Zarit Burden Interview; GAS, goal attainment scaling.

KiresukJSmithACardilloJEGoal Attainment Scaling: Applications, Theory, and MeasurementHillsdale, NJLawrence Erlbaum Associates1994

 Google Scholar