Lower limb orthopedic surgery in children and adolescents with cerebral palsy is well captured using individualized Goal Attainment Scale (GAS) and Canadian Occupational Performance Measure (COPM) goals.

Abstract

Purpose: To investigate individualized goals set and goal attainment following lower limb orthopedic surgery for children and adolescents with cerebral palsy (CP).

Materials and method: Retrospective chart review. Individualized goals set prior to orthopedic surgery using the Canadian Occupational Performance Measure (COPM) and/or Goal Attainment Scaling (GAS) with follow-up within 18 months post-surgery were analyzed. Goals were categorized into functional mobility, leisure, self-care and productivity.

Results: 44 children met the inclusion criteria, mean age 12.5 years (range 4.8-18.2yrs, SD 3.9), GMFCS I = 6, II = 19, III = 6, IV = 9, V = 4. In total 111 goals were analyzed, n = 79 COPM goals and n = 32 GAS goals. Clinically and statistically positive change was demonstrated in the COPM post-surgery, with mean changes of 3.74 (<0.0001) for performance and 4.26 (p < 0.0001) for satisfaction with performance. Of the 32 GAS goals set, 22 had an expected to much greater than expected outcome.

Conclusions: COPM goals demonstrated clinically and statistically significant improvement in performance and satisfaction with performance for children of all GMFCS levels post-surgery. GAS goals were not universally met. This study highlights the importance of individualized goal setting and recommends further evaluation into non-achievement of goals and the relationship between goal outcomes and surgery type.