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Rehab Measures: Glasgow Outcome Scale - Extended

Link to instrument

 

Title of Assessment

Glasgow Outcome Scale - Extended 

Acronym

GOS-E

Instrument Reviewer(s)

Initially reviewed by Erin Donnelly PT, MSPT, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 6/2012

Summary Date

1/17/2013 

Purpose

Used to classify global outcome in TBI survivors. Primarily intended to describe outcome in groups of cases for research purposes. Utility for individual assessment is limited.

Description

  • 8 levels in the scale
  • Minimum Score = 1; Maximum Score = 8
  • Specific questions to determine upper or lower levels of disability are dictated by the structured interview

1 = Dead

2 = Vegetative State

Condition of unawareness with only reflex responses but with periods of spontaneous eye opening.

3 = Low Severe Disability

4 = Upper Severe Disability

Patient who is dependent for daily support for mental or physical disability, usually a combination of both. If the patient can be left alone for more than 8h at home it is upper level of SD, if not then it is low level of SD.

5 = Low Moderate Disability

6 = Upper Moderate Disability

Patients have some disability such as aphasia, hemiparesis or epilepsy and/or deficits of memory or personality but are able to look after themselves. They are independent at home but dependent outside. If they are able to return to work even with special arrangement it is upper level of MD, if not then it is low level of MD.

7 = Low Good Recovery

8 = Upper Good Recovery

Resumption of normal life with the capacity to work even if pre-injury status has not been achieved. Some patients have minor neurological or psychological deficits. If these deficits are not disabling then it is upper level of GR, if disabling then it is lower level of GR.

 

Area of Assessment

 

Body Part

 

ICF Domain

Body Structure; Body Function; Activity; Participation 

Domain

 

Assessment Type

 

Length of Test

06 to 30 Minutes 

Time to Administer

Less than 15 minutes

Number of Items

8 levels, determined by a structured interview of 19 questions  

Equipment Required

No equipment required for examination.

Training Required

No training required.

Type of training required

No Training 

Cost

Free 

Actual Cost

No cost

Age Range

 

Administration Mode

 

Diagnosis

Acquired Brain Injury; Traumatic Brain Injury 

Populations Tested

  • Traumatic Brain Injury
  • Non-traumatic Brain Injury

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Traumatic Brain Injury (Wilson, et al. 2000; n= 135; 36.74 (13.9) years (range 16-69 years old); admissions to regional neurosurgical unit with TBI, mean time post injury= 7.39 months (range 5-10 months post injury) ): assessed 5-10 months post injury and compared to the amount of time in PTA following injury.

GOS-E

<1 hour PTA

1-24 hr PTA

1-7 days

> 7 days

TOTAL

GR UPPER

6

6

3

3

18

GR LOWER

4

6

16

8

34

MD UPPER

2

1

11

10

24

MD LOWER

1

2

6

11

20

SD UPPER

4

9

13

SD LOWER

6

20

26

TOTAL

13

15

46

61

135

Test-retest Reliability

Brain Injury (Wilson, et al. 2002; n=141, mean age of 44.8 (19.1) years, administered either two postal surveys or phone vs. mail)

Mean interval between completion of first questionnaire and second questionnaire = 14.4 (8.8) days; mean interval between phone and mail survey 6.4 (5.0 days).

  • Excellent test-retest reliability for postal surveys (weighted kappa coefficient = .98)
  • Excellent test-retest reliability for phone vs. mail survey (K=.92)

Brain Injury: (Pettigrew, et al. 2003; n=30 ; mean age=36.77 (12.11) years old, (range from 19-68 years old); mean time post injury= 214 days (range from 168- 270 days) )

  • Compared in-person versus telephone interview using the GOS-E
  • Excellent test-retest reliability (weighted kappa coefficient = .92)

Interrater/Intrarater Reliability

Brain Injury (participants from 32 trauma centers): (Lu, et al. 2010; tested three methods to improve agreement of ratings on 6 pre- and post-injury narratives completed by medical staff.)

  • Good to excellent interrater reliability (weighted kappa coefficient = .70-.95) improved by a method that encouraged the rating of the 5 level Glasgow Outcome Scale first, prior to determining GOS-E level, with central monitoring

Brain Injury: (Mean age 39 (16) years, range 16-76) comparing psychologist and nurse, one in person and one by phone (Pettigrew, et al. 2003)

  • Excellent Interrater reliability (weighted kappa coefficient = .84-.92)
  • Minor Injury (weighted kappa coefficient = .89) and Severe Injury (weighted kappa coefficient = .92)

Brain Injury : (Wilson, et al. 1998; n= 50; mean age = 39.4 (range 18-76 years old); post injury mean= 10.2 months(range 5-17 months post injury) )

  • Excellent inter rater reliability (weighted kappa coefficient = .85)

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Predictive Validity

Evaluating whether the GOS-E is a better predictor of Neuropsychological Outcome Measures than the GOS- 3 months post injury

Mild to moderate Traumatic Brain Injury: (Levin, et al., 2001; n= 43; mean age= 34.3 (14.1) years; evaluated at 1 month post injury and followed at 3 months post injury; n=44, mean age 36.9 years, patients with general trauma)

  • GOSE demonstrated stronger relationships with measures of functional outcome, affect and neuropsychological function, with greater sensitivity than GOS. However, scores for GOSE were not significantly different in the general trauma group than for those with mild to moderate TBI.

Construct Validity (Convergent/Discriminant)

Brain Injury (ages 16-69): (Wilson, et al., 2000)

  • Excellent correlation with the DRS (r=-.89) and
  • Excellent correlation with the Beck Depression (r=-.64)
  • Adequate correlation with the length of PTA (r=-.52) and
  • Adequate correlation with the Barthel Index (r=.46) and
  • Adequate correlation with self-rated subscales of the NFI (r = ranges from .37-.63)
  • Adequate to excellent correlation with subscales of the SF-36 (r= ranges from .47-.71)
  • Adequate to excellent correlation with the subscales of the NFI-rated by relative/friend (r= ranges from .47-.69)

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Traumatic Brain Injury: (Hall, et al. 2001; n= 48; mean age= 37 years; mean time post injury= not documented, ranged from 2-9 years post injury)

  • Ceiling Effect: 69% for GOS, supporting the need for the more detailed GOS-E measure

Responsiveness

Not Established

Professional Association Recommendations

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

NR

NR

LS

LS

LS

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

TBI EDGE

No

Yes

Yes

Not reported

Considerations

According to recommendations (Teasdale, et al, 1998) the GOS-E should not be done too early in a person’s recovery because the degree of resumption of normal life cannot be assessed at this stage.

Studies support the improved validity of the GOS-E when using the structured interview questions.

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Bibliography

Hall, K. M., Bushnik, T., et al. (2001). "Assessing traumatic brain injury outcome measures for long-term follow-up of community-based individuals." Arch Phys Med Rehabil 82(3): 367-374. Find it on PubMed

Levin, H. S., Boake, C., et al. (2001). "Validity and sensitivity to change of the extended Glasgow Outcome Scale in mild to moderate traumatic brain injury." J Neurotrauma 18(6): 575-584. Find it on PubMed

Lu, J., Marmarou, A., et al. (2010). "A method for reducing misclassification in the extended Glasgow Outcome Score." J Neurotrauma 27(5): 843-852. Find it on PubMed

Nichol, A. D., Higgins, A. M., et al. (2011). "Measuring functional and quality of life outcomes following major head injury: common scales and checklists." Injury 42(3): 281-287. Find it on PubMed

Pettigrew, L. E., Wilson, J. T., et al. (2003). "Reliability of ratings on the Glasgow Outcome Scales from in-person and telephone structured interviews." J Head Trauma Rehabil 18(3): 252-258. Find it on PubMed

Teasdale, G. M., Pettigrew, L. E., et al. (1998). "Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale." J Neurotrauma 15(8): 587-597. Find it on PubMed

Wilson, J. T., Edwards, P., et al. (2002). "Reliability of postal questionnaires for the Glasgow Outcome Scale." J Neurotrauma 19(9): 999-1005. Find it on PubMed

Wilson, J. T., Pettigrew, L. E., et al. (1998). "Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use." J Neurotrauma 15(8): 573-585. Find it on PubMed

Wilson, J. T., Pettigrew, L. E., et al. (2000). "Emotional and cognitive consequences of head injury in relation to the glasgow outcome scale." J Neurol Neurosurg Psychiatry 69(2): 204-209. Find it on PubMed

Year published

 

Instrument in PDF Format

No 
Approval Status Approved 
 
Attachments
Created at 1/17/2013 11:25 AM  by Jason Raad 
Last modified at 9/3/2014 12:54 PM  by Jason Raad