Patient-centered evaluation of outcomes from rehabilitation for chronic disabling spinal disorders: the impact of personal goal achievement on patient satisfaction.
BACKGROUND
The multiplicity of biopsychosocial and economic facets of chronic disabling back and/or neck pain complicates the treatment outcomes measurement. Our previous work showed that personal functional goal achievement contributed more toward patient satisfaction with the outcome than did traditional self-reports of pain and physical function or measured strength, flexibility, and endurance among functional restoration program (FRP) graduates with chronic disabling back and/or neck pain.


OBJECTIVE
The primary goal was to compare the impact on patient satisfaction of pain and functional goal achievement versus self-reports of pain and physical function.


METHODS
This was an observational study of all patients with chronic disabling back and/or neck pain completing an FRP between June 2008 and May 2009.


METHODS
Before the treatment, participants recorded personal 3-month goals for pain, work, recreation, and activities of daily living. At least 3 months later, all graduates were sent a follow-up survey displaying the patient's pretreatment functional goals and eliciting the patient's assessment of functional goal achievement; current pain magnitude, "satisfaction with the overall results for your pain problem;" and responses to the Short Form-36v2 Physical Functioning subscale (PF-10).


METHODS
Pain goal achievement was calculated as the difference between the pretreatment pain goal and follow-up pain magnitude. Linear regression was used to evaluate the association between satisfaction and four variables (follow-up pain; PF-10; pain goal achievement; functional goal achievement), individually and then together in a full model.


RESULTS
Of the 82 patients surveyed, 62 responded completely. Mean age was 44 years, with 48% female and 35% on worker's compensation. The model R(2) combining all four variables explained 0.6033 of the variance in satisfaction. Each variable by itself was significantly related to patient satisfaction at p<.001, but the overlap in association was large. The unique contributions (R(2)) to the variation in satisfaction were the following: functional goal achievement: 0.0471; PF-10 score: 0.0229; pain magnitude: 0.0178; and pain goal achievement: 0.0020.


CONCLUSIONS
At least 3 months after the treatment, functional goal achievement had by far the greatest impact on patient satisfaction, followed by PF-10 score, pain magnitude, and, finally, pain goal achievement. Functional goal achievement has great potential as a tool for patient-centered treatment decision-making and outcomes measurement for people with chronic disabling back and/or neck pain and their health care providers.
Department of Orthopaedics, The Spine Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. Rowland.G.Hazard@Hitchcock.org
Rowland G
RG
Hazard
Kevin F
KF
Spratt
Christine M
CM
McDonough
Colleen M
CM
Olson
Elizabeth S
ES
Ossen
Eric M
EM
Hartmann
Raynee J
RJ
Carlson
Jenna
J
LaVoie
D000203:Activities of Daily Living; D000328:Adult; D001416:Back Pain / Q000534:rehabilitation*; D059350:Chronic Pain / Q000534:rehabilitation*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation; D005260:Female; D006040:Goals; D006801:Humans; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000534:rehabilitation*; D010147:Pain Measurement; D017060:Patient Satisfaction; D016896:Treatment Outcome