Patient led goal setting in chronic low back pain—What goals are important to the patient and are they aligned to what we measure?

doi:10.1016/j.pec.2015.04.012

Patient Education and Counseling

Volume 98, Issue 8, August 2015, Pages 1035-1038

https://doi.org/10.1016/j.pec.2015.04.012 Get rights and content

Highlights

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This study examined goals important to patients in cLBP.
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Patient led goals were compared to current clinical and research outcome measures.
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The majority of goals did not correspond with current practice measures.
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Guidelines need to be reviewed to embed a more patient centred approach.

Abstract

Objective

To determine the extent of alignment between clinical outcome measures and patient-derived goals for the management of chronic low back pain (cLBP).

Methods

A customised, patient-led goal setting intervention was implemented facilitated by a physiotherapist, in which participants identified problem areas and developed strategies to address them. Patient goals were compared to the most commonly used outcome measures in cLBP as well as research outcomes recommended by the IMMPACT consortium.

Results

From 20 participants, a total of 27 unique goals were identified, the most common goal related to physical activity (49%). Comparison of participant goals to the most common measures used by physiotherapists found none of the goals could be aligned. Comparison of goals and domains with IMPACCT outcome domains found 76% of the goals were aligned with physical functioning and 16% with emotional functioning.

Conclusion

This study has identified goals important to patients in cLBP, these were varied, and most did not correspond with current clinical measures.

Practice implications

Clinical outcome measures may not be providing accurate information about the success of treatments that are meaningful to the patient. Clinicians should consider a collaborative approach with cLBP patients to determine treatment interventions that are driven by patient preference.

Introduction

The use of standardised outcome measures in the management of chronic low back pain (cLBP) is recognised worldwide. They are used to guide the health care professional (HCP) in their clinical reasoning as well as benchmarking treatment goals and success. Outcome measures are based on quantitative parameters creating the benefit of determining specific treatment goals, and hence they are ideal for assessing outcomes [1]. Several investigations into the use of outcome measures by physiotherapists have found that measures usually focus on impairments of pain, range of motion (ROM) (e.g. bending forward) and strength [2], [3].

In 2005, The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consortium recommended that six core outcome domains should be considered when designing chronic pain clinical trials, see Table 1 [4]. The most commonly used measures in cLBP research assess disability, pain, psychosocial function and quality of life [5].

This study aims to explore and identify those goals that are important to cLBP patients and to investigate the extent of their alignment with outcome measures used in both clinical and research settings.

Section snippets

Study design

A single arm pre-post intervention longitudinal cohort study was conducted. The study involved a customised, patient-led goal setting intervention facilitated by a physiotherapist, in which participants identified personally relevant problem areas and were coached to develop strategies to address them. Problem areas, goals and strategies were recorded and analysed to determine the types and prevalence of goals identified by the participant. Participant goals set in the study were compared to

Participants

Twenty participants completed the intervention, 18 recruited from the university advertisement and 2 from a physiotherapy outpatient department (Fig. 1).

Baseline characteristics of study participants are reported in Table 3. Our sample was comparative to normative data representative of cLBP patients in gender, age, length of pain and pain intensity [7].

Participant goals

Participants set a total of 63 new goals (average 3.15 goals/participant). Some goals were the same for different participants, however a total

Discussion

This study aimed to explore the goals that are important to patients with cLBP. Our analysis results suggest that the patient derived goals are idiosyncratic. In the majority of cases (>70%), participants had a combination of physical and psycho–social goals. Our results support previous findings that have found cLBP patient goals, patient satisfaction parameters and perspectives on recovery to be varied [8], [9], [10], [11].

Outcome measures are used to guide intervention, improve outcome of

Funding

This study was self-funded.

Conflict of interest statement

All authors declare no conflict of interest.

Ethics approval

University of Sydney Human Research Ethics Committee Ref: 12-2009/12340; St Vincent's Hospital Human Research and Ethics Committee Ref: 12/157.

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Short communicationPatient led goal setting in chronic low back pain—What goals are important to the patient and are they aligned to what we measure?

Highlights

Abstract

Objective

Methods

Results

Conclusion

Practice implications

Introduction

Section snippets

Study design

Participants

Participant goals

Discussion

Funding

Conflict of interest statement

Ethics approval

Man Ther

Pain

Arch Phys Med Rehabil

Applying outcomes management to clinical practice

J Neuromusculoskelet Syst

Physiotherapy management of low back pain: does practice match the Dutch guidelines?

Aust J Physiol

Core outcome measures for chronic pain clinical trials: IMMPACT recommendations

Pain

Evaluating common outcomes for measuring treatment success for chronic low back pain

Spine

Goals in rehabilitation teamwork

Disabil Rehabil

Designing pain research from the patient's perspective: what trial end points are important to patients with chronic pain?

Pain Med

Short communication
Patient led goal setting in chronic low back pain—What goals are important to the patient and are they aligned to what we measure?