Patient-Centered Goals After Lumbar Spine Surgery: A Secondary Analysis of Cognitive-Behavioral-Based Physical Therapy Outcomes From a Randomized Controlled Trial.

Rogelio A Coronado Hiral Master Jordan A Bley Payton E Robinette Emma K Sterling Michael T O'Brien Abigail L Henry Jacquelyn S Pennings Susan W Vanston Brittany Myczkowski Richard L Skolasky Stephen T Wegener Kristin R Archer

Phys Ther

Department of Orthopedic Surgery, Center for Musculoskeletal Research, Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Published: September 2022

This study aimed to understand the link between achieving personal goals and patient-reported outcomes in individuals who underwent a telephone-based cognitive-behavioral physical therapy after spine surgery.
The analysis involved 112 participants who set and tracked their goals during six therapy sessions, categorizing their success in meeting these goals using a scoring system.
Results showed that participants who successfully met their goals experienced significant improvements in physical function at both 6 and 12 months, suggesting that goal achievement may positively influence recovery outcomes.

Objective: The purpose of this study was to examine the association between goal attainment and patient-reported outcomes in patients who engaged in a 6-session, telephone-based, cognitive-behavioral-based physical therapy (CBPT) intervention after spine surgery.

Methods: In this secondary analysis of a randomized trial, data from 112 participants (mean age = 63.3 [SD = 11.2] years; 57 [51%] women) who attended at least 2 CBPT sessions (median = 6 [range = 2-6]) were examined. At each session, participants set weekly goals and used goal attainment scaling (GAS) to report goal attainment from the previous session. The number and type of goals and percentage of goals met were tracked. An individual GAS t score was computed across sessions. Participants were categorized based on goals met as expected (GAS t score ≥ 50) or goals not met as expected (GAS t score < 50). Six- and 12-month outcomes included disability (Oswestry Disability Index), physical and mental health (12-Item Short-Form Health Survey), physical function (Patient-Reported Outcomes Measurement Information System), pain interference (Patient-Reported Outcomes Measurement Information System), and back and leg pain intensity (numeric rating scale). Outcome differences over time between groups were examined with mixed-effects regression.

Results: Participants set a median of 3 goals (range = 1-6) at each session. The most common goal categories were recreational/physical activity (36%), adopting a CBPT strategy (28%), exercising (11%), and performing activities of daily living (11%). Forty-eight participants (43%) met their goals as expected. Participants who met their goals as expected had greater physical function improvement at 6 months (estimate = 3.7; 95% CI = 1.0 to 6.5) and 12 months (estimate = 2.8; 95% CI = 0.04 to 5.6). No other outcome differences were noted.

Conclusions: Goal attainment within a CBPT program was associated with 6- and 12-month improvements in postoperative physical functioning.

Impact: This study highlights goal attainment as an important rehabilitation component related to physical function recovery after spine surgery.

Download full-text PDF	Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10071580	PMC
http://dx.doi.org/10.1093/ptj/pzac091	DOI Listing

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