I may be exaggerating the importance of this preliminary study but I think it is revolutionary and the wave of the future.
The study took 20 patients with persistent low back pain (LBP) and tested a unique yet common sense intervention approach. The intervention was patient-led goal setting facilitated by a physiotherapist over a 2-month period (no manual therapy and no exercise prescription).
The patients attended once every 2 weeks and were given a “Goal Handbook”.
The handbook was used to record their personal goals, their progress, any barriers and strategies to achieve the goals.
The goals were set based on the patients’ personal preferences.
Although this was not an RCT, the patients had significant improvements in their disability, pain, fear avoidance beliefs, quality of life and self-efficacy over the 2-month period and for another 2 months after the study.
It is important to note that the patients in this study had greater improvements in their pain and disability scores than those in typical manual therapy or exercise based intervention studies.
Instead of focusing only on the exact location of the pain and its intensity, we also need to ask every patient, “Tell me, what is it that you really wish to get back into doing?”
For most of my PT career, I naturally focused on getting rid of my patients’ pain and getting them back to work. I wrongly assumed that I knew what my patients really wanted out of physiotherapy.
Since learning this concept, I take more time to help identify the problems and the goals that are important to them. If they choose their own specific goals, they may have a greater sense of personal control over their health and be more engaged in dialog with you about their life.
Previous studies have shown that when goals meet the intrinsic needs of a person, motivation to achieve them is increased.
What is most fascinating about the study was that only 13.5% of the goals set by the patients were actually achieved within the 2-month period of the study. The fact that most of the goals were not 100% achieved did not seem to influence the positive outcomes in perceived pain and disability.
It takes conscious effort to see patients as people with complex pasts, experiences and unique life goals instead of just as painful body parts.
Reference: Gardner T, et al 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.
Goals
