Background: Clinical outcomes used for patients with low back pain (LBP), often fail to incorporate patient-centeredness and may not fully reflect the scope of a patient?s individual needs. Goal Attainment Scaling (GAS), where patients initiate and identify his/her particular goal(s), may better reflect goals that are important for individual treatment success. GAS has been inadequately developed and validated for patients with chronic LBP receiving physical therapy. Objectives/Specific Aims: The primary objective of this proposal is to establish feasibility in a pilot test that develops a reliable and valid application of GAS for patients with chronic LBP receiving physical therapy.
Specific Aim 1 : To develop a new application of GAS procedures to be used by physical therapists treating patients with chronic LBP. Design: Pilot prospective cohort study. Population: For phase 1, we will recruit 30 adults with a history of non-specific chronic LBP. For phase 2, we will recruit 30 patients with chronic LBP seeking physical therapy from the USF Morsani Center for Advanced Healthcare. Methods: In Phase 1, we will conduct a qualitative study, centered on grounded theory by conducting focus groups of patients with chronic LBP to identify an inventory of goals, which will be used to generate a series of questions to assist the patient in generating goals in Phase 2. In Phase 2, we will pilot-test GAS in patients with chronic LBP to determine its feasibility in a clinical setting. Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), Minimum Dataset, and GAS will be obtained prior to and following care. Two physical therapists will administer GAS along with usual care for each patient prior to and following care. A third physical therapist will observe the outcome collection to establish feasibility, fidelity, and reliability.Data Analysis: Sub-aim 1a: Following the transcription of field notes, participant views will be examined to identify emerging themes and an interpretive analysis will be performed to explain the findings. The researchers will analyze those themes and researcher triangulation will be used to establish validity, or trustworthiness. Sub-aim 1b: Descriptive data for all variables will be calculated. GAS process, feasibility, and fidelity, will be evaluated by measuring the time to administer GAS, checklist adherence, and nature of the goals identified. Inter-rater reliability and criterion validity of GAS scores will be assessed using a Spearman rank correlations to examine the association between two independent examiners and between GAS and ODI scores, respectively. Responsiveness will be assessed by comparing standardized response means (SRMs) for the NRS, ODI, and GAS, while Chi square analyses will be used to determine if differences exist between the tests. Impact: GAS will enhance the measurement of outcomes for not only patients with chronic LBP, but for other patients receiving physical therapy, thereby improving the patient-centered care and ultimately the quality of life for patients.

Public Health Relevance

Our long-term goal is to further develop and improve the measurement of treatment success, effectiveness of interventions, and patient-centered care for patients with musculoskeletal conditions, which are a significant burden in the United States. This application will specifically develop Goal Attainment Scaling for patients with chronic low back pain in a physical therapy setting by pilot testing this measure to establish feasibility.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Small Research Grants (R03)
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Healthcare Effectiveness and Outcomes Research (HEOR)
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Nourjah, Parivash
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University of South Florida
Physical Medicine & Rehab
Schools of Medicine
United States
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