title: What psychological and physical changes predict patients' attainment of personally meaningful goals six months following a CBT based pain management intervention?
abstract: To examine the influence of demographic measures, and changes in physical ability, pain, self-efficacy and emotional distress on Goal Attainment Scaling (GAS) scores, after a 15-day CBT based pain management programme.
  
  
  
  Chronic pain patients (N = 257) were referred; 225 (88%) completed the programme and were invited for follow up six months later. One hundred and sixty-two (63%), (mean age 47.7, 71% female) completed the reassessment procedures. GAS scores (which were also repeated at the end the programme), an 11-point Pain Numerical Rating Scale, Pain Self-Efficacy Questionnaire, Hospital Anxiety and Depression Scale, distance walked in 5 mins, number of sit/stand repetitions in 1 min and number of stairs climbed in 1 min were measured on the first day and six months following the programme.
  
  
  
  At six months post discharge, changes in goal attainment, physical measures, pain intensity, depression and self-efficacy were observed. Hierarchical regression showed change in GAS was predicted by improvement in walking tolerance and self-efficacy.
  
  
  
  The achievement of personally important goals was most significantly associated with change in walking ability and self-efficacy, while controlling for the influence of change in pain. Implications for Rehabilitation Chronic pain can reduce psychological and physical functioning, leading to a reduction in meaningful activities. Achievement of personally important activities as measured by Goal Attainment Scaling can be a more sensitive measure of programme outcome than that captured by many other standard measures. Self-efficacy is an important predictor of attainment of patient preferred goals following a CBT based pain management programme, and could be emphasized during treatment along with improved walking ability, to enhance patients' goal achievement.
authors.affiliation: a Psychology Department , The University of Hertfordshire , Hatfield , UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Oliver
authors.affiliation: b Royal National Orthopaedic Hospital , Prosthetics Rehabilitation Unit , Middlesex , UK.
authors.forename: Keren
authors.initials: K
authors.lastname: Fisher
authors.affiliation: c Chelsea and Westminster Hospital , Pain Team , London , UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Childs
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000628:therapy; D005260:Female; D006040:Goals; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D020377:Self Efficacy; D013315:Stress, Psychological / Q000628:therapy; D055815:Young Adult
keywords: Chronic pain; Cognitive Behavioral Therapy; Goal Attainment Scaling; self-efficacy