PSiM 2017 - Patient led goal setting in CLBP (Tania Gardner)

PATIENT LED GOAL SETTING IS AN EFFECTIVE TREATMENT OF CHRONIC LOW BACK PAIN Tania Gardner Introduction: Patient led goal setting has not been investigated in CLBP.The aim of this study was to test the effectiveness and healthcare use of a patient led goal setting intervention compared with usual care in CLBP. Methods: Randomized controlled trial with 2 arms(1) patient-led goal setting (PLGS),(2)usual care.Intervention:Participants experiencing CLBP(N=75) were randomly allocated to one of two study arms(PLGS N=37,usual care N=38).The PLGS group were involved in a patient-led goal-setting intervention,facilitated by a physiotherapist over a 2 month period and followed up at 4 months. Participants assigned to the usual care group were offered 3 face to face sessions for advice on exercise (baseline,2 months and 4 month time points) and asked to continue with their normal routine of back care.Outcome measures:Outcome measures of disability, pain intensity, quality of life, self-efficacy, fear avoidance and healthcare utilisation were measured at pre, post treatment and 4 months. Results:The mean outcome scores for disability and pain intensity improved significantly from pre to post treatment for both groups. The intervention group showed significant change in quality of life, self-efficacy and fear avoidance measures from pre to post treatment measures.The intervention group improved significantly more than the usual care group in all measures. Improvements were maintained at the 4 month follow up for the intervention group. A significant reduction from pre-treatment to 4 months in the use of prescription medications visits to allied health and other treatments ie; massage,acupuncture was shown with the intervention group. Process evaluation: Recruitment of participants was difficult and initial high drop out rate with usual care participants was experienced. Protocol was amended to maximise usual care retainment with good effect.One investigator conducted the intervention group which supports a consistent method however limits the generalizability for the intervention across multiple clinicians. Discussion:Our findings confirm that a patient led goal-setting intervention is an effective intervention for the management of chronic low back pain showing significant improvements in all measures. The intervention resulted in a reduction of prescription medication use as well as utilisation of allied health and other health interventions.