Suitability of Goal Attainment Scaling in Older Adult Populations with Neurodegenerative Disease Experiencing Cognitive Impairment: A Systematic Review and Meta-Analysis.

INTRODUCTION: Identifying responsive outcome measures for assessing functional change related to cognition, communication, and quality of life for individuals with neurodegenerative disease is important for intervention design and clinical care. Goal Attainment Scaling (GAS) has been used as an outcome measure to formally develop and systematically measure incremental progress toward functional, patient-centered goals in clinical settings. Evidence suggests that GAS is reliable and feasible for use in older adult populations and in adult populations with cognitive impairment, but no review has assessed the suitability of GAS in older adults with neurodegenerative disease experiencing dementia or cognitive impairment, based on responsiveness. This study conducted a systematic review to evaluate the suitability of GAS as an outcome measure for older adult populations with neurodegenerative disease experiencing dementia or cognitive impairment, based on responsiveness. METHODS: The review was registered with PROSPERO and performed by searching ten electronic scientific databases (PubMed, Medline OVID, CINAHL, Cochrane, Embase, Web of Science, PsycINFO, Scopus, OTSeeker, REHABDATA) and four registries (Clinicaltrials.gov, Grey Literature Report, Mednar, OpenGrey). A summary measure of responsiveness (post-intervention minus pre-intervention mean GAS T-score) was compared across eligible studies using a random-effects meta-analysis. Risk of bias in included studies was assessed using the NIH Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group. RESULTS: 882 eligible articles were identified and screened by two independent reviewers. Ten studies met inclusion criteria for the final analysis. Of the ten included reports, 3 focus on all-cause dementia, 3 on multiple sclerosis, 1 on Parkinson's disease, 1 on mild cognitive impairment, 1 on Alzheimer's disease, and 1 on primary progressive aphasia. Responsiveness analyses showed pre- and post-intervention GAS goals were significantly different from zero (Z = 7.48, p < 0.001), with post-intervention GAS scores being higher than pre-intervention GAS scores. Three included studies showed a high risk of bias, 3 showed a moderate risk of bias, and 4 showed a low risk of bias. Overall risk of bias of included studies was rated as moderate. CONCLUSION: GAS showed an improvement in goal attainment across different dementia patient populations and intervention types. The overall moderate risk of bias suggests that while bias is present across included studies (e.g., small sample size, unblinded assessors), the observed effect likely represents the true effect. This suggests that GAS is responsive to functional change and may be suitable for use in older adult populations with neurodegenerative disease experiencing dementia or cognitive impairment.

Executive functioning and social skills in children with epileptic seizures and non-epileptic seizures.

Children experiencing epileptic seizures (ES) and children experiencing non-epileptic seizures (NES) may experience deficits in both executive functioning and in social skills, but little research has examined differences in executive functioning between the two groups and no studies have examined the relationship between executive functioning and social skills in pediatric ES and NES groups. The purposes of this study were to determine if ES/NES group differences exist for executive functioning and to determine if executive functioning was related to social skills in these groups. Children (N = 43) were recruited from epilepsy monitoring units (EMU) at Primary Children's Medical Center and Phoenix Children's Hospital. The NES group consisted of 15 participants (67 % female, M age at test = 12.62, SD = 3.33), and the ES group consisted of 28 participants (50 % female, M age at testing = 11.79, SD = 3.12). Parents and children completed the Social Skills Improvement System (SSIS) Rating Scales, and the Behavior Rating Inventory of Executive Function (BRIEF). No significant differences on measures of executive functioning were observed between ES and NES groups. Parent reports of poorer behavioral regulation correlated to parent reports of poorer social skills in both groups, but neither parent nor child ratings of executive functioning correlated with child-reported social skills. This finding suggests there may be differences between parent and child self-observations of executive functioning and social skills in both NES and ES groups. Limitations to this study and directions for future research are discussed.