Feasibility of Goal Attainment Scaling in Chronic Low Back Pain: Protocol for Training & Implementation in an Outpatient Physical Therapy Setting (Preprint)

Abstract

Patient engagement in decisions regarding their healthcare may lead to improved outcomes and improved adherence to treatment plans. While there are several options for involving patients in their healthcare, goal setting is a readily accessible method for physical therapists to increase the involvement of patients in healthcare decisions. Physical therapy goals are often provider-generated and based on subjective information or standardized fixed-item patient-reported outcome measures. However, these outcome measures may provide a limited scope of activity and participation limitations which may not capture the needs of individual patients. Goal Attainment Scaling (GAS) is a patient-centered approach involving patients in setting meaningful goals. While GAS has been shown to be reliable, valid, and sensitive to change in various population, there is limited evidence in the United States about utilizing GAS in the physical therapist management of patients with chronic low back pain (LBP).

The purpose of this report is to describe the protocol for a study to a) develop an application of GAS procedures to be used by physical therapists treating patients with chronic LBP in the United States and b) to test the feasibility of applying GAS procedures in chronic LBP in an outpatient physical therapy setting.

This study used a mixed-methods design with two (2) phases (Phase 1: Qualitative, Phase 2: Quantitative). The qualitative phase of the study employed focus groups of patients with chronic LBP to identify an inventory of goals that are important and measurable. A series of leading questions was developed from this inventory to assist physical therapists in collaboratively establishing goals with patients in the clinical setting. The quantitative phase of the study pilot-tested the inventory developed in the qualitative phase in patients with chronic LBP to determine feasibility, reliability, validity, and responsiveness. We will also compare how well GAS captures change over time as compared to traditional fixed-item patient-reported measures.

We anticipate that this study will demonstrate that GAS can be implemented successfully by outpatient physical therapists, and it will demonstrate clinically important changes that are important to patients with chronic LBP.

GAS represents an opportunity for patient-centered care in the physical therapy management of chronic LBP. While GAS is not new, it has never been studied in a real-world clinical setting for the physical therapy management of chronic LBP. Due to the unique time and productivity constraint, for GAS to be successfully implemented in this environment, we must demonstrate that clinicians can be trained efficiently and reliably, that GAS can be implemented in the clinical setting in under 15 minutes, and that GAS is able to detect clinically meaningful change in patient outcomes.

Not applicable.