Factors Associated with Goal Attainment in Children with Cerebral Palsy: An Ambidirectional Cohort Study

Objectives: This study aimed to identify factors influencing goal attainment in children with cerebral palsy (CP) while evaluating the appropriateness of established therapeutic goals. Study design: An ambidirectional cohort study Setting: The Rehabilitation Department, Siriraj Hospital, Bangkok, Thailand Subjects: Patients aged 0 to 15 years with a diagnosis of cerebral palsy were eligible if they had received at least two sessions of goal-directed therapy (GDT) and a post-therapy Goal Attainment Scale (GAS) evaluation between January 2016 and March 2022. Methods: A total of 462 goals were evaluated using the GAS. Clinical variables, including age, sex, CP type, functional classification, goals, comorbidities, and therapy frequency, were analyzed for associations with goal attainment. Results: Clinical data were collected from 111 pediatric CP patients (51.4% female) undergoing GDT at a university hospital rehabilitation unit. The participants had a mean age of 4.7 years (SD = 2.7), with spastic CP being the most prevalent type (77.7%). The goals for high-functioning participants frequently targeted ambulation and hand function, while the goals for low-functioning groups focused on sitting, hand function, and swallowing. Overall, therapeutic goals were found to be appropriate, with a GAS T score of 50.2. The Gross Motor Function Classification System (GMFCS) levels I and II emerged as the sole statistically significant independent predictor of goal attainment (p = 0.04). Conclusion: Children with CP who demonstrate greater gross motor function exhibit a greater likelihood of therapeutic goal attainment. The GMFCS should inform the selection of appropriate therapeutic goals. High-functioning children may benefit from active goals such as improving ambulation and hand function, while low-functioning groups progress best with passive goals centered on preventing complications and achieving early motor milestones.