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

Abstract

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.

Keywords: Arthrodesis; Back Pain; Postoperative Care; Psychotherapy; Rehabilitation.

Figure 1

Percentage of goals set within each goal category. CBPT = cognitive-behavioral–based physical therapy; PT = physical therapy.

Figure 2

Baseline, 6-month, and 12-month mean outcome scores by goal attainment. Error bars are 95% CIs. *Significant outcome difference between groups. NRS = numeric rating scale; ODI = Oswestry Disability Index; PROMIS = Patient-Reported Outcomes Measurement Information System; SF-12 = 12-Item Short-Form Health Survey.