136. Influence of goal attainment scaling on cognitive behavioral based physical therapy outcomes after lumbar spine surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Patient-centered goal setting is an important component of behavioral interventions for chronic pain. Limited data exist on the relationship between goal attainment during cognitive-behavioral based physical therapy (CBPT) and pain-related outcomes. <h3>PURPOSE</h3> The purpose of this study was to examine the relationship between CBPT goal attainment and pain-related outcomes in a cohort of patients who completed a 6-week telephone-based CBPT intervention after lumbar spine surgery. <h3>STUDY DESIGN/SETTING</h3> Secondary analysis from a randomized trial comparing postoperative CBPT and an education program. The primary results of the trial showed superiority of CBPT in an intervention completers only analysis. <h3>PATIENT SAMPLE</h3> This study included 108 participants (mean ± SD age = 63.5 ± 11.3 years, 54 [50%] female, 92 [85%] White) who completed the CBPT intervention were included. <h3>OUTCOME MEASURES</h3> Six and 12-month outcomes included physical function (PROMIS), pain interference (PROMIS), and back and leg pain intensity (Brief Pain Inventory). <h3>Methods</h3> At each session, CBPT participants used goal attainment scaling (GAS) to set goals and report goal attainment from the previous session. The number and type of goals and percentage of goals met were recorded. A GAS t-score for achievement of goals across all sessions was computed for each patient. Patients were grouped as high or low goal attainment based on a GAS t-score of 50, which indicates goals were met as expected. Outcome differences between groups at each follow-up time point were examined using linear regression analyses controlling for baseline outcome score. Alpha was set at the 0.05 level for statistical significance. <h3>Results</h3> Participants set a median of 3 goals (range: 1 to 6) at each CBPT session. The most common goals were related to participating in a physical/recreational activity (36%), adopting a cognitive or behavioral strategy (28%), exercising (11%), or performing activities of daily living (11%). The least common goals related to social activities (2%). Forty-six (43%) participants met criteria for high goal attainment (mean % goals met = 87% compared to 64% in the low goal attainment group, p<0.001). Greater improvements in the high goal attainment group were observed in physical function at 6 (unstandardized beta = 4.2, p < 0.05) and 12 months (unstandardized beta = 3.5, p < 0.05) and back pain intensity at 12 months (unstandardized beta = -0.9 p < 0.05). <h3>Conclusions</h3> The attainment of personalized goals within a CBPT intervention was an important factor related to improvements in physical functioning after spine surgery. Implementing a structured process for setting personalized goals and tracking goal attainment may be an essential aspect of a biopsychosocial approach for addressing functional impairment following surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.