Objective: To report the most common expectations prior to focused ultrasound (FUS) treatment in essential tremor (ET) patients using the Goal Attainment Scaling method (GAS).

Background: GAS was developed by Kiresuk and Sherman with the purpose of scoring the extent to which a patient’s individual goals were achieved after intervention. The method allows for individualized goal setting and a measurement algorithm that is standardized for statistical analysis. To date, there is limited use of this method in ET patients.

Method: All ET patients evaluated for unilateral FUS VIM thalamotomy from April 2021- February 2022 in the Movement Disorder Clinic at KU Medical Center were included. GAS was utilized in the pre-operative assessment of the potential surgical candidates as one of the methods for assessing expected outcome achievement. Each patient identified three to four tasks they hoped to improve after FUS. The tasks were weighted for importance to the patient and difficulty in achievement, then calculated using the set algorithm to establish a baseline score.

Results: Fifty patients with ET (26 women, 24 men) were assessed and established GAS baseline measurements, and a total of 190 goals were established. The mean age of the patient population was 70.8 years. The five most common goals were for improvement in “Writing” (20.5%), “Eating/Drinking” (20%), “Technology Use” (9.5%), “Holding Items” (7.9%), and “Personal Hygiene” (5.3%). The five most common goals in women were improvement in “Writing” (23.2%), “Eating/Drinking” (18.3%), “Holding Items” (10.1%), “Technology Use” (9.1%), and “Personal Hygiene” (7.1%). The five most common goals for men were improvement in “Eating/Drinking” (22.0%), “Writing” (17.6%), “Hand Tool Use” (9.9%), “Technology Use” (9.9%), and “Holding Items” (5.5%).

Conclusion: Several of the common goals reported by ET patients, including holding items, hand tool use, and technology use, are not included in the most commonly used tremor rating scales. Future versions of the current tremor scales or new tremor scales should consider adding these items

References: Kiresuk TJ, Sherman RE. Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Ment Health J. 1968 Dec;4(6):443-53. doi: 10.1007/BF01530764. PMID: 24185570.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/goals-for-improvement-in-essential-tremor-patients-following-focused-ultrasound-vim-thalamotomy/