Patient led goal setting in chronic low back pain [Neurosurgery Wiki]

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=====Patient led goal setting in chronic low back pain=====

====Case series====
===2016===
Twenty participants (male = nine) in a patient led goal setting in [[chronic low back pain]], facilitated by a physiotherapist over a 2-month period with two monthly follow-up sessions after treatment conclusion. Participants, guided by the therapist, identified problem areas of personal importance, defined goals, and developed evidence-based strategies to achieve the goals. Participants implemented the strategies independently between sessions. Primary outcome measures of disability and pain intensity were measured at baseline, 2, and 4 months. Secondary measures of quality of life, stress and anxiety, self-efficacy, and fear of movement were also taken.

Significant improvements (repeated analysis of variance P < 0.05) were seen in measures of disability, pain, fear avoidance, quality of life, and self-efficacy over the period of intervention and were maintained for a further 2 months after treatment conclusion.

This intervention is novel because the goals set are based on patients' personal preferences, and not on treatment guidelines. The findings confirm that a patient-centered goal-setting intervention is a potentially effective intervention for the management of chronic [[low back pain]] showing significant improvements in both quality of life and pain intensity
((Gardner T, Refshauge K, McAuley J, Goodall S, Hübscher M, Smith L. Patient-led
Goal Setting: A Pilot Study Investigating a Promising Approach for the Management
of Chronic Low Back Pain. Spine (Phila Pa 1976). 2016 Sep 15;41(18):1405-13. doi:
10.1097/BRS.0000000000001545. PubMed PMID: 26937604.
)).

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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.

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.

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

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
((Gardner T, Refshauge K, McAuley J, Goodall S, Hübscher M, Smith L. Patient led
goal setting in chronic low back pain-What goals are important to the patient and
are they aligned to what we measure? Patient Educ Couns. 2015 Aug;98(8):1035-8.
doi: 10.1016/j.pec.2015.04.012. Epub 2015 Apr 27. PubMed PMID: 25959985.
)).