Development of a structured Goal Attainment Scaling framework for spastic foot treated with selective tibial neurotomy: an approach using a drop-down menu.

BACKGROUND: Goal Attainment Scaling (GAS) is increasingly used to assess individualized outcomes in spasticity management, yet its clinical adoption remains limited due to challenges in defining and standardizing goals. OBJECTIVES: This study aimed to facilitate the clinical use of GAS in adults undergoing selective tibial neurotomy for spastic foot management by developing a comprehensive, structured drop-down menu of goal areas to enhance its accessibility, efficiency, and usability in daily practice. METHODS: This cohort study included 59 adults with spastic equinovarus foot of various etiologies who underwent selective tibial neurotomy followed by rehabilitation between 2021 and 2024 in a university hospital. A GAS-based goal-oriented approach was systematically applied. For each participant, broad functional and symptomatic goals were identified and then refined into measurable target activities through standardized GAS examples. All individualized goals were categorized according to the International Classification of Functioning, Disability, and Health (ICF) framework. RESULTS: Across the study population, 158 goals were defined and distributed into ICF domains: 17% in body functions, 80% in activities, and 3% in participation, spanning 29 distinct goal areas. A structured drop-down menu of these goal areas was generated, detailing specific target activities, potential indicators of change, and assessment criteria to guide GAS scoring. CONCLUSION: This study introduces a methodological framework to optimize the use of GAS for the management of spastic foot. The structured drop-down menu balances standardization and individualization, facilitating clinically relevant and personalized goal setting. This approach supports broader integration of GAS into multidisciplinary spasticity management and neurosurgical practice, enhancing personalized care and outcome measurement.