Global Rating of Change Scale

What is a Global Rating of Change Scale?

A Global Rating of Change Scale (GRoC) is a self-report outcome measure used in research and clinical practice to assess a patient’s perceived change in health status over time. It is commonly used to monitor chronic conditions like lower back pain, shoulder disorders, and other musculoskeletal conditions (Kamper et al., 2009), helping clinicians evaluate treatment effectiveness and patient satisfaction.

The scale asks patients to compare their current health status or functional ability to a previous point in time, typically before treatment or an intervention. This allows for assessing clinically meaningful changes in symptoms, function, or overall well-being from the patient’s perspective.

GRoC scales typically follow a global scale with a numerical range, where positive values indicate varying degrees of improvement, negative values represent different levels of worsening, and a midpoint (such as 0 or 1) signifies no change. However, depending on the clinical or research context, different types of GRoC scales may vary in numerical range, wording, and interpretation. Some scales use an 11-point format (-5 to +5) or a 15-point format (-7 to +7), while others may adopt a visual analog scale (VAS), where patients mark their perceived change along a continuous line.

How does our Global Rating of Change Scale template work?

Our template includes the Patient Global Impression of Change (PGIC) Scale, a type of Global Rating of Change Scale widely used in clinical settings to assess a patient’s overall health status and perceived improvement over time. It is particularly valuable for patients managing chronic pain and other long-term conditions. The PGIC is a 7-point scale that captures a patient’s subjective impression of change, ranging from significant worsening to significant improvement (Ferguson & Scheman, 2009).

Follow these steps to get started:

Step 1: Download the template

Get a copy of the Global Rating of Change Scale form by clicking the "Use template" button. This lets you modify its content via the Carepatron app. For a PDF version, you can also click "Download."

Step 2: Explain the scale to the patient

Before having the patient complete the form, explain how the GRC scale works. The patient will rate their perceived change since a specific point in time, such as the beginning of treatment. The scale ranges from 1 to 7, where 7 indicates a great deal better, and 1 means no change. Encourage the patient to consider their overall change rather than just how they feel today.

Step 3: Have the patient select a response

Ask the patient to mark the number that best represents their experience. Their response will help you gauge their perception of progress, allowing you to tailor their treatment plan accordingly.

Step 5: Add your notes and observations

If applicable, document any additional insights regarding the patient’s response. This could include observed symptom changes, functional improvements, or external factors that may have influenced their rating.

Step 6: Save the form and track progress

Store the completed form in the patient’s records to monitor changes over time. Regularly using the GRC scale enables you to track progress, adjust interventions, and improve patient outcomes.

What are the benefits of using this scale?

The Global Rating of Change Scale  offers a systematic review of several benefits of using the rating of change scales in both clinical practice and research settings:

• Patient-centered assessment: The GRoC scale provides a direct means for patients to communicate their perceptions of change in their health status or functional abilities. Involving patients in the assessment process ensures their perspectives are central to evaluating treatment outcomes.
• Sensitive to individual change: The scale captures individualized changes experienced by patients, allowing for a nuanced understanding of treatment effectiveness. It accommodates variations in patient response and accounts for improvements and health status deteriorations.
• Quantifiable measurement: Despite its subjective nature, GRoC scales generate quantifiable data through numerical ratings. This enables statistical analysis and comparison across groups or time points, facilitating evidence-based clinical practice and research decision-making.
• Clinically relevant outcomes: By focusing on meaningful changes to patients, a GRoC scale assesses clinically pertinent outcomes that align with patients' treatment goals and priorities. This promotes patient-centered care and enhances patient satisfaction with treatment outcomes.
• Ease of administration: A GRoC scale is relatively simple and quick to administer, making it suitable for routine clinical practice. Its straightforward instructions and standardized format minimize the burden on patients and healthcare providers.
• Complementary to other measures: A GRoC scale complements objective and other patient-reported outcome measures, comprehensively assessing treatment outcomes. It offers unique insights into patients' perceptions of change that may not be captured by traditional outcome measures alone.
• Facilitates shared decision-making: The GRoC scale facilitates shared decision-making between patients and healthcare providers by eliciting patients' perspectives on treatment outcomes. It encourages collaborative discussions about treatment goals, expectations, and preferences.

Next steps

Once the Global Rating of Change Scale  has been completed, the results must be interpreted and integrated into the patient’s care plan. As a self-report outcome measure, the GRoC provides valuable insights into a patient’s general health status and perception of progress, particularly for pain patients managing chronic conditions.

Analyze the patient’s response

Review the selected rating to determine whether the patient perceives a successful outcome from their treatment. A positive score indicates perceived improvement, while a negative score suggests worsening symptoms or functionality. Comparing this score with other self-report outcome measures, such as pain scales or functional assessments, can provide a more comprehensive view of their general health status.

Compare with objective measures

While the patient’s global impression of change is critical, it is beneficial to cross-reference their score with objective clinical data. This may include pain scales, mobility tests, or functional assessments to validate their reported pain intensity and overall improvement.

Adjust treatment plan if needed

Consider modifying the treatment plan if the patient reports little to no improvement or worsening symptoms. This may involve adjusting therapeutic interventions, exploring alternative treatments, or referring them for further evaluation. A higher score, indicating a successful outcome, reinforces the effectiveness of the current approach.

Document and monitor progress over time

Recording each assessment helps track long-term trends in the patient’s general health status. Regularly using the GRoC allows you to monitor fluctuations in pain intensity and overall well-being, providing a clear picture of treatment effectiveness and patient response.

References

Ferguson, L., & Scheman, J. (2009). Patient global impression of change scores within the context of a chronic pain rehabilitation program. The Journal of Pain, 10(4), S73. https://doi.org/10.1016/j.jpain.2009.01.258

Kamper, S. J., Maher, C. G., & Mackay, G. (2009). Global rating of change scales: A review of strengths and weaknesses and considerations for design. Journal of Manual & Manipulative Therapy, 17(3), 163–170. https://doi.org/10.1179/jmt.2009.17.3.163