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Spine J. 2012 Dec;12(12):1132-7. doi: 10.1016/j.spinee.2012.09.003. Epub 2012 Oct 12.

Patient-centered evaluation of outcomes from rehabilitation for chronic disabling spinal disorders: the impact of personal goal achievement on patient satisfaction.

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  • 1Department of Orthopaedics, The Spine Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.



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.


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.


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.


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).


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.


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.


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.

Copyright © 2012 Elsevier Inc. All rights reserved.

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