***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the responsiveness ( sensitivity to change ) of 6 shoulder outcome instruments . METHODS In a prospect i ve cohort study of 153 total shoulder arthroplasties , outcome was measured by the Short Form 36 ( SF-36 ) ; Disabilities of the Arm , Shoulder , and H and question naire ( DASH ) ; Shoulder Pain and Disability Index ( SPADI ) ; American Shoulder and Elbow Surgeons question naire for the shoulder ( ASES ) ;  and the Constant ( Murley ) Score ( CS ) .  Responsiveness was mainly quantified by effect sizes before and 6 months after operation . Sensitivity analysis of the effects by receiver operating characteristic ( ROC ) curves was performed to determine the instruments ' ability to classify effects into global health change assessment categories . RESULTS Effect sizes of the self- assessment total scores were 0.71 , 1.19 , 2.10 , and 2.13 for the SF-36 , DASH , SPADI , and ASES , respectively . The clinical ASES and the CS had effect sizes of 1.87 and 2.23 , respectively . The SPADI ( effect size 2.12 ) and the CS ( effect size 2.72 ) were most responsive for pain . For functioning , the patient ASES ( effect size 2.10 ) , the CS ( effect size 1.82 ) , and the clinical ASES ( effect size 1.85 ) were almost equal . The SF-36 bodily pain scale and most scores of the condition-specific instruments showed a significant area under the ROC of up to 0.77 . CONCLUSION The SPADI and /or the CS are the most suitable for short , responsive , shoulder-specific assessment . The more expensive patient ASES can be used for most responsive shoulder-function assessment . For a comprehensive measurement of health and quality of life , the DASH and /or the SF-36 should be added to the set Objective To compare the sensitivity to change of two HIV-health-related  quality of life  ( HRQoL ) question naires – the Medical Outcomes Study ( MOS-HIV ) and Multidimensional Quality of Life ( MQOL-HIV ) for use in clinical research . Methods A sample of 296 HIV-infected patients starting or switching antiretroviral treatment  were r and omly assigned either the MOS-HIV or MQOL-HIV question naires at baseline and after 3 months of treatment . Ceiling and floor effects were evaluated . Sensitivity to change was assessed by comparing the percentage of dimensions with statistically significant pre – post-treatment changes and the effect sizes in those groups of patients who reported improvement and no change in self-report questions ( overall , physical , mental and social health status ) and clinical characteristics ( number of opportunistic infections , number of symptoms , viral load level and CD4 + count ) . Results Ceiling effects were found in HRQoL scores at baseline and after 3 months of treatment in Pain ( 42.3 - 41.6 % ) , Role Function ( 73.1–77.6 % ) and Social Function ( 60.9–63 % ) on MOS-HIV subscales , and in Social Support ( 38.2–37.6 % ) and Partner Intimacy ( 38.2–33.7 % ) on MQOL-HIV . For patients who improved in self-reported and objective clinical indicators of health status , mean percentage of dimensions with statistically significant pre – post-treatment changes was 86.4 % on MOS-HIV and 50 % on MQOL-HIV , where mean st and ardized effect size was 0.45 on MOS-HIV and 0.33 on MQOL-HIV for the total of dimensions . Conclusions Based on sensitivity to change the results suggest that for 3 months both question naires can be used , but the MOS-HIV is more sensitive than the MQOL-HIV for use in clinical research Objectives : To underst and the treatment goals of Alzheimer ’s disease ( AD ) patients , carers , and physicians ; to estimate whether clinical ly important goals are met during treatment with donepezil ; and to compare a measure of goal attainment with st and ard measures used to evaluate AD treatment . Methods : In a 12 month phase IV trial , 108 patients with mild to moderate AD , their primary carers , and treating physicians  set goals assigned to five domains , using  Goal Attainment Scaling ( GAS ) as the primary outcome . Goal attainment was assessed quarterly . GAS scores were correlated with st and ard outcomes , including the Alzheimer ’s Disease Assessment Scale-Cognitive ( ADAS-cog ) , and the Clinician ’s Interview-Based Impression of Change-Plus ( CIBIC-plus ) . Results : Physicians set fewer goals ( 342 , mean ( SD ) per patient=3 ( 1 ) ) than patients /carers ( 855 , mean=9 ( 3 ) ) , particularly in leisure ( 20 % by physicians compared with 76 % by patients /carers ) , and social interaction ( 24 % versus 49 % ) . Physicians observed statistically significant improvement in global goal attainment for six months , and patients /carers for nine months . Patients /carers described consistent goal attainment , whereas physicians observed variable effects , such as decline in cognition but improved social interaction and behaviour . Physician global GAS scores correlated highly with the CIBIC-plus at weeks 12 ( r= −0.82 ) and 52 ( r=−0.80 ) , but not with the ADAS-cog ( r=0.12 and r=−0.45 , respectively ) . Patient/carer global GAS scores correlated moderately with the physician ’s CIBIC-plus ( week 12 r=−0.51 ; week 52 r=−0.56 ) , and nominally with the ADAS-cog . Conclusions : Patients /carers and physicians differ in their expectations and impressions of treatment effects . Clinical ly important changes correlated only modestly with psychometric tests . Attainment of treatment goals does not accord with a simplistic model in which successful AD treatment means that all declines uniformly improve OBJECTIVES To underst and how commonly diminution of verbal repetition was a goal of treatment in patients with Alzheimer disease ( AD ) , how commonly that goal was achieved , whether goal attainment might be attributable to galantamine treatment , and whether change in verbal repetition is a marker of the overall treatment response . METHODS This is a secondary analysis of the Video-Imaging Synthesis of Treating Alzheimer 's Disease study , a 4-month , double-blind , r and omized , placebo-controlled trial of galantamine in 130 community-dwelling patients with mild to moderate AD . The primary outcome was Goal Attainment Scaling , in which individualized problems identified by patients /caregivers and treating physicians were assessed bimonthly . RESULTS Reduction of verbal repetition was set as a treatment goal in 44 % ( n = 57 ) of r and omized patients . More patients /caregivers ( 32 % ) set repetition goals than did physicians ( 18 % ) . After 4 months , more galantamine-treated patients showed diminution of verbal repetition ( 58 % ) than did placebo-treated patients ( 24 % ; p < 0.01 ) . Reduction of verbal repetition correlated with improvement in clinical measures , but not in st and ardized ones . CONCLUSIONS Reduction of verbal repetition is a common goal of Alzheimer disease treatment . After 4 months , patients treated with galantamine were more likely to experience a reduction of verbal repetition than those treated with placebo . Diminution of verbal repetition was associated with other improvements , suggesting it might be a clinical marker of a positive treatment response OBJECTIVE To assess the effect of a 6-month interdisciplinary customized intervention based on goal attainment scaling and aim ed at improving the quality of care provided by long-term care facilities to frail older adults . DESIGN A pair-matched group-r and omized trial with quality of care measurements taken before and after the intervention and 6 months later . SETTING Forty unregulated small-to-medium sized long-term care facilities delivering inadequate care to at least one resident . Facilities were matched on baseline quality of care , health district , and size . One member of each pair was then r and omly allocated to the intervention , the other acting as a control . STUDY PARTICIPANTS The trial involved 201 frail older adults r and omly selected from the 40 participating facilities . INTERVENTION The intervention was tailored to the main quality problems identified at baseline in the facility . The first task of the intervention team was to set weighted quality improvement goals with the facility manager , which were then recorded on a goal attainment follow-up guide . Subsequent monthly on-site visits , interspersed with frequent telephone calls , were meant to assist the manager and staff to implement permanent changes in the areas of care targeted for improvement . Main outcome measure . Quality of care measured with the Quality of Care ( QUALCARE ) Scale , a multidimensional instrument that uses a 5-point scale to assess six subdimensions of care : environmental , physical , medical management , psychosocial , human rights , and financial . A score greater than 2 is considered indicative of inadequate care . RESULTS The intervention effect on the overall quality of care was neither clinical ly nor statistically significant . Change from baseline to the end of the intervention averaged .21 and .22 in the experimental and control conditions , respectively ( P = 0.86 ) . CONCLUSION Attainment of preset quality improvement objectives did not translate into detectable improvements in the care provided to residents This study represents a long-term effort to find optimal techniques for evaluating outcome in patients who have undergone total joint arthroplasty . Sensitivity of five health status question naires was studied in a longitudinal evaluation of orthopedic surgery . The question naires ( Arthritis Impact Measurement Scales [ AIMS ] , Functional Status Index [ FSI ] ,  Health  Assessment  Question naire [ HAQ ] , Index of  Well  Being [ IWB ] , and Sickness Impact Profile  [ SIP ] ) were administered to 38 patients with end-stage arthritis at three points in time : two weeks before hip or knee arthroplasty , and at three-month and 12- to 15-month follow-up . Response values ( i.e. , changes within patients ) were calculated on four scales : global health , pain , mobility , and social function . By the three-month follow-up , most instruments detected large mean responses in global health , pain scores , and mobility . Smaller changes on these scales were found between three and 12 to 15 months . Social function showed small to modest gains at successive follow-ups . St and ardized response means were calculated to assess sensitivity to detect change . Confidence intervals for these indices were constructed using a jackknife procedure , and significance tests were performed by pairing selected indices . Finally , the study projected sample sizes required to assess a new therapy , using each response . These statistical tools facilitated comparisons among instruments and may prove useful in other setting Five health status instruments were administered in r and om order to 50 arthritis patients before and after total joint arthroplasty . Relative efficiency and sensitivity in measurement of change in pain , mobility and physical function , social role and social activity , and global health were assessed . The instruments had highly correlated scores , but had differences in certain dimensions . Inter-instrument differentials were larger for social and global outcomes than for pain or mobility . NO single instrument consistently outperformed the others . A method for determining relative efficiency is described Global assessment s are Food and Drug Administration-required primary outcome measures in trials of putative antidementia drugs . Global ratings are intended to provide an index of clinical importance of change that can not be obtained from quantitative assessment measures such as mental status examinations . We examined the performance of a global assessment of change instrument , the  Clinician Interview-Based Impression ( CIBI ) , in the  placebo group of a 30-week , r and omized , double-blind clinical trial of tacrine in patients with Alzheimer 's disease . Initially there were 184 placebo patients , of whom 125 completed the 30-week study .  Descriptive statistics , correlations with changes on other assessment instruments , and test-retest reliability were determined for the CIBI . At week 30 , clinicians rated more than 40 % of patients on the CIBI as unchanged . The CIBI ratings were weakly but significantly correlated , in the expected direction , with change scores on the quantitative cognitive assessment s. The CIBI was modestly reliable on test- retest at weeks 22 and 24 but less reliable compared with other quantitative outcome measures . Modifications of the CIBI that might improve its reliability and acceptance include ( 1 ) no restrictions on the form of the bedside mental status assessment , ( 2 ) inclusion of caregiver input , and ( 3 ) better definition of ratings on the global scale . Global instruments , if properly constructed , can provide an index of clinical ly important change for the assessment of dementia patients Background : Although cholinesterase inhibitors have produced statistically significant treatment effects , their clinical meaningfulness in Alzheimer 's disease is disputed . An important aspect of clinical meaningfulness is the extent to which an intervention meets the goals of treatment . Methods : In this r and omized controlled trial , patients with mild to moderate Alzheimer 's disease were treated with either galantamine or placebo for 4 months , followed by a 4-month open-label extension during which all patients received galantamine . The primary outcome measures were Goal Attainment Scaling ( GAS ) scores from assessment s by clinicians and by patients or caregivers of treatment goals set before treatment and evaluated every 2 months . Secondary outcome measures included the cognitive subscale of the Alzheimer 's Disease Assessment Scale ( ADAS-cog ) , the Clinician 's Interview-based Impression of Change plus Caregiver Input ( CIBIC-plus ) , the Disability Assessment for Dementia ( DAD ) and the Care 
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The involvement of patient and /or caregiver in the goal - setting procedure is possible and multiple domains can be implemented .
The possibility to set at least 3 realistic goals per patient in less than 30 min is unclear and the need for involvement of a blinded assessor is not well established .
Conclusion : GAS proved to be useful on important aspects of an outcome measure for psychogeriatric patients with cognitive disorders .
Since other relevant aspects showed mixed results and the number of studies investigating the use of GAS in psychogeriatric patients with cognitive disorders is small , the evidence is not strong enough yet to state that GAS is an applicable outcome measure in this population