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Published in: BMC Musculoskeletal Disorders 1/2021

Open Access 01-12-2021 | Research article

Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice

Authors: Olav Amundsen, Nina Køpke Vøllestad, Ingebrigt Meisingset, Hilde Stendal Robinson

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

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Abstract

Background

Goal setting is linked to person-centred care and is a core component in physiotherapy, but the associations between goal classes, patient characteristics and outcome measures for musculoskeletal disorders has not been investigated. The study’s purpose was to examine 1) how goals used in clinical practice for patients with musculoskeletal disorders (MSD) are distributed in classes based on ICF, 2) if goal classes were associated with patient characteristics and 3) whether goal classes were associated with treatment outcome.

Methods

Data analysis from a longitudinal observational study (N = 2591). Goals were classified in symptom, function/structure, activity/participation and non-classifiable. Associations between patient characteristics and goal classes were examined using x2 and one-way ANOVA. Association between goal classes and outcomes were examined using multiple logistic and linear regression models. Outcomes are reported at 3 months or end of treatment if prior to 3 months.

Results

There was a high variability in goals used for patients with MSD. 17% had symptom goals, 32.3% function/structure, 43.4% activity/participation and 7.4% non-classifiable goals. We found significant associations between goal classes and age, gender, severity, region of pain/diagnosis and emotional distress (all p < .001). Activity/participation goals were associated with better outcomes on GPE (OR 1.80, 95% CI 1.23–2.66). Non-classifiable goal was associated with poorer outcomes on pain intensity (B .87, 95% CI .32–1.43).

Conclusion

There is an association between goal classes and patient characteristics. Including activity/participation in the main goal was associated with better outcomes for GPE and having a non-classifiable goal was associated with poorer outcomes for pain intensity.

Trial registration

The project is approved by the Regional committee for Medical and Health Research Ethics in Norway (REC no. 2013/2030). https://​clinicaltrials.​gov/​ct2/​show/​NCT03626389.
Literature
1.
go back to reference Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1211–59.CrossRef Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1211–59.CrossRef
2.
go back to reference Lin I, WL, Waller R, Goucke R, Nagree Y, Gibberd M, SL, Maher CG, O’Sullivan PPB. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54:79–86. Lin I, WL, Waller R, Goucke R, Nagree Y, Gibberd M, SL, Maher CG, O’Sullivan PPB. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54:79–86.
4.
go back to reference Wade DT. Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil. 2009;23(4):291–5.CrossRef Wade DT. Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil. 2009;23(4):291–5.CrossRef
5.
go back to reference Mittrach R, Grill E, Walchner-Bonjean M, Scheuringer M, Boldt C, Huber EO, et al. Goals of physiotherapy interventions can be described using the international classification of functioning. Disabil Health Physiother. 2008;94(2):150–7. Mittrach R, Grill E, Walchner-Bonjean M, Scheuringer M, Boldt C, Huber EO, et al. Goals of physiotherapy interventions can be described using the international classification of functioning. Disabil Health Physiother. 2008;94(2):150–7.
6.
go back to reference Bovend'Eerdt TJ, Botell RE, Wade DT. Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clin Rehabil. 2009;23(4):352–61.CrossRef Bovend'Eerdt TJ, Botell RE, Wade DT. Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clin Rehabil. 2009;23(4):352–61.CrossRef
7.
go back to reference Gardner T, Refshauge K, McAuley J, Goodall S, Hubscher M, Smith L. Patient led goal setting in chronic low back pain-what goals are important to the patient and are they aligned to what we measure? Patient Educ Couns. 2015;98(8):1035–8.CrossRef Gardner T, Refshauge K, McAuley J, Goodall S, Hubscher M, Smith L. Patient led goal setting in chronic low back pain-what goals are important to the patient and are they aligned to what we measure? Patient Educ Couns. 2015;98(8):1035–8.CrossRef
8.
go back to reference Henry SG, Bell RA, Fenton JJ, Kravitz RL. Goals of chronic pain management: do patients and primary care physicians agree and does it matter? Clin J Pain. 2017;33(11):955–61.CrossRef Henry SG, Bell RA, Fenton JJ, Kravitz RL. Goals of chronic pain management: do patients and primary care physicians agree and does it matter? Clin J Pain. 2017;33(11):955–61.CrossRef
9.
go back to reference Crombez G, Lauwerier E, Goubert L, Van Damme S. Goal pursuit in individuals with chronic pain: a personal project analysis. Front Psychol. 2016;7:966.CrossRef Crombez G, Lauwerier E, Goubert L, Van Damme S. Goal pursuit in individuals with chronic pain: a personal project analysis. Front Psychol. 2016;7:966.CrossRef
10.
go back to reference Lohman S, Decker J, Müller M, Strobl R, Grill E. The ICF Forms a Useful Framework for Classifying Individual Patient Goals in Post-Acute Rehabilitation. J Rehabil Med. 2011;43(2):151–5. Lohman S, Decker J, Müller M, Strobl R, Grill E. The ICF Forms a Useful Framework for Classifying Individual Patient Goals in Post-Acute Rehabilitation. J Rehabil Med. 2011;43(2):151–5.
11.
go back to reference van Dulmen SA, van der Wees PJ, Bart Staal J, Braspenning JC. Nijhuis-van der Sanden MW. Patient reported outcome measures (PROMs) for goalsetting and outcome measurement in primary care physiotherapy, an explorative field study. Physiotherapy. 2017;103(1):66–72.CrossRef van Dulmen SA, van der Wees PJ, Bart Staal J, Braspenning JC. Nijhuis-van der Sanden MW. Patient reported outcome measures (PROMs) for goalsetting and outcome measurement in primary care physiotherapy, an explorative field study. Physiotherapy. 2017;103(1):66–72.CrossRef
12.
go back to reference Verwoerd M, Wittink H, Maissan F, de Raaij E, Smeets R. Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: a systematic review. Musculoskelet Sci Pract. 2019;42:13–37.CrossRef Verwoerd M, Wittink H, Maissan F, de Raaij E, Smeets R. Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: a systematic review. Musculoskelet Sci Pract. 2019;42:13–37.CrossRef
13.
go back to reference Chester R, Jerosch-Herold C, Lewis J, Shepstone L. Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. Br J Sports Med. 2018;52(4):269–75.CrossRef Chester R, Jerosch-Herold C, Lewis J, Shepstone L. Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. Br J Sports Med. 2018;52(4):269–75.CrossRef
14.
go back to reference Hill JC, Fritz JM. Psychosocial influences on low back pain, disability, and response to treatment. Phys Ther. 2011;91(5):712–21.CrossRef Hill JC, Fritz JM. Psychosocial influences on low back pain, disability, and response to treatment. Phys Ther. 2011;91(5):712–21.CrossRef
15.
go back to reference Iijima H, Aoyama T, Fukutani N, Isho T, Yamamoto Y, Hiraoka M, et al. Psychological health is associated with knee pain and physical function in patients with knee osteoarthritis: an exploratory cross-sectional study. BMC Psychol. 2018;6(1):19.CrossRef Iijima H, Aoyama T, Fukutani N, Isho T, Yamamoto Y, Hiraoka M, et al. Psychological health is associated with knee pain and physical function in patients with knee osteoarthritis: an exploratory cross-sectional study. BMC Psychol. 2018;6(1):19.CrossRef
16.
go back to reference Artus M, Campbell P, Mallen CD, Dunn KM, van der Windt DA. Generic prognostic factors for musculoskeletal pain in primary care: a systematic review. BMJ Open. 2017;7(1):e012901.CrossRef Artus M, Campbell P, Mallen CD, Dunn KM, van der Windt DA. Generic prognostic factors for musculoskeletal pain in primary care: a systematic review. BMJ Open. 2017;7(1):e012901.CrossRef
17.
go back to reference Kindler LL, Jones KD, Perrin N, Bennett RM. Risk factors predicting the development of widespread pain from chronic back or neck pain. J Pain. 2010;11(12):1320–8.CrossRef Kindler LL, Jones KD, Perrin N, Bennett RM. Risk factors predicting the development of widespread pain from chronic back or neck pain. J Pain. 2010;11(12):1320–8.CrossRef
18.
go back to reference Wijnhoven HAH, de Vet HCW, Picavet HSJ. Prevalence of musculoskeletal disorders is systematically higher in women than in men. Clin J Pain. 2006;22(8):717–24.CrossRef Wijnhoven HAH, de Vet HCW, Picavet HSJ. Prevalence of musculoskeletal disorders is systematically higher in women than in men. Clin J Pain. 2006;22(8):717–24.CrossRef
19.
go back to reference Viester L, Verhagen VALM, Hengel KMO, Koppes LL, van der Beek AJ, Bongers PM. The relation between body mass index and musculoskeletal symptoms in the working population. BMC Musculoskelet Disord. 2013;14(238):1–9. Viester L, Verhagen VALM, Hengel KMO, Koppes LL, van der Beek AJ, Bongers PM. The relation between body mass index and musculoskeletal symptoms in the working population. BMC Musculoskelet Disord. 2013;14(238):1–9.
20.
go back to reference Barclay L. Exploring the factors that influence the goal setting process for occupational therapy intervention with an individual with spinal cord injury. Aust Occup Ther J. 2002;49(1):3–13.CrossRef Barclay L. Exploring the factors that influence the goal setting process for occupational therapy intervention with an individual with spinal cord injury. Aust Occup Ther J. 2002;49(1):3–13.CrossRef
21.
go back to reference Moberly NJ, Dickson JM. Goal conflict, ambivalence and psychological distress: concurrent and longitudinal relationships. Personal Individ Differ. 2018;129:38–42.CrossRef Moberly NJ, Dickson JM. Goal conflict, ambivalence and psychological distress: concurrent and longitudinal relationships. Personal Individ Differ. 2018;129:38–42.CrossRef
22.
go back to reference Hardy JK, Crofford LJ, Segerstrom SC. Goal conflict, distress, and pain in women with fibromyalgia: a daily diary study. J Psychosom Res. 2011;70(6):534–40.CrossRef Hardy JK, Crofford LJ, Segerstrom SC. Goal conflict, distress, and pain in women with fibromyalgia: a daily diary study. J Psychosom Res. 2011;70(6):534–40.CrossRef
23.
go back to reference Clarke SP, Oades LG, Crowe TP, Caputi P, Deane FP. The role of symptom distress and goal attainment in promoting aspects of psychological recovery for consumers with enduring mental illness. J Ment Health. 2009;18(5):389–97.CrossRef Clarke SP, Oades LG, Crowe TP, Caputi P, Deane FP. The role of symptom distress and goal attainment in promoting aspects of psychological recovery for consumers with enduring mental illness. J Ment Health. 2009;18(5):389–97.CrossRef
24.
go back to reference Moseng T, Tveter AT, Holm I, Dagfinrud H. The Patient-Specific Functional Scale - A useful tool for physiotherapists working in primary care. Fysioterapeuten. 2013;2:20–6. Moseng T, Tveter AT, Holm I, Dagfinrud H. The Patient-Specific Functional Scale - A useful tool for physiotherapists working in primary care. Fysioterapeuten. 2013;2:20–6.
25.
go back to reference Evensen KAI, Robinson HS, Meisingset I, Woodhouse A, Thielemann M, Bjorbaekmo WS, et al. Characteristics, course and outcome of patients receiving physiotherapy in primary health care in Norway: design of a longitudinal observational project. BMC Health Serv Res. 2018;18(1):936.CrossRef Evensen KAI, Robinson HS, Meisingset I, Woodhouse A, Thielemann M, Bjorbaekmo WS, et al. Characteristics, course and outcome of patients receiving physiotherapy in primary health care in Norway: design of a longitudinal observational project. BMC Health Serv Res. 2018;18(1):936.CrossRef
26.
go back to reference Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins symptom checklist (HSCL). A measure of primary symptom dimensions. Mod Probl Pharmacopsychiatry. 1974;7(0):79–110.CrossRef Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins symptom checklist (HSCL). A measure of primary symptom dimensions. Mod Probl Pharmacopsychiatry. 1974;7(0):79–110.CrossRef
27.
go back to reference Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17(3):163–70.CrossRef Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17(3):163–70.CrossRef
28.
go back to reference World Health Organization. International classification of functioning, disability and health (ICF). Geneva: WHO; 2001. World Health Organization. International classification of functioning, disability and health (ICF). Geneva: WHO; 2001.
29.
go back to reference van der Roer N, Ostelo RW, Bekkering GE, van Tulder MW, de Vet HC. Minimal clinically important change for pain intensity, functional status, and general health status in patients with nonspecific low back pain. Spine (Phila Pa 1976). 2006;31(5):578–82.CrossRef van der Roer N, Ostelo RW, Bekkering GE, van Tulder MW, de Vet HC. Minimal clinically important change for pain intensity, functional status, and general health status in patients with nonspecific low back pain. Spine (Phila Pa 1976). 2006;31(5):578–82.CrossRef
30.
go back to reference Gardner T, Refshauge K, McAuley J, Hubscher M, Goodall S, Smith L. Goal setting practice in chronic low back pain. What is current practice and is it affected by beliefs and attitudes? Physiother Theory Pract. 2018;34(10):795–805.CrossRef Gardner T, Refshauge K, McAuley J, Hubscher M, Goodall S, Smith L. Goal setting practice in chronic low back pain. What is current practice and is it affected by beliefs and attitudes? Physiother Theory Pract. 2018;34(10):795–805.CrossRef
31.
go back to reference Carrol LJ, Lis A, Weiser S, Torti J. How well do you expect to recover, and what does recovery mean, anyway? Qualitative study of expectations after a musculoskeletal injury. Phys Ther. 2016;96(6):797–807. Carrol LJ, Lis A, Weiser S, Torti J. How well do you expect to recover, and what does recovery mean, anyway? Qualitative study of expectations after a musculoskeletal injury. Phys Ther. 2016;96(6):797–807.
32.
go back to reference Ponte-Allan M, Giles GM. Goal setting and functional outcomes in rehabilitation. Am J Occup Ther. 1999;53(6):646–9.CrossRef Ponte-Allan M, Giles GM. Goal setting and functional outcomes in rehabilitation. Am J Occup Ther. 1999;53(6):646–9.CrossRef
33.
go back to reference Wollburg E, Braukhaus C. Goal setting in psychotherapy: the relevance of approach and avoidance goals for treatment outcome. Psychother Res. 2010;20(4):488–94.CrossRef Wollburg E, Braukhaus C. Goal setting in psychotherapy: the relevance of approach and avoidance goals for treatment outcome. Psychother Res. 2010;20(4):488–94.CrossRef
34.
go back to reference Rosen NO, Muise A, Bergeron S, Impett EA, Boudreau GK. Approach and avoidance sexual goals in couples with provoked Vestibulodynia: associations with sexual, relational, and psychological well-being. J Sex Med. 2015;12(8):1781–90.CrossRef Rosen NO, Muise A, Bergeron S, Impett EA, Boudreau GK. Approach and avoidance sexual goals in couples with provoked Vestibulodynia: associations with sexual, relational, and psychological well-being. J Sex Med. 2015;12(8):1781–90.CrossRef
35.
go back to reference Pastor-Mira MA, Lopez-Roig S, Martinez-Zaragoza F, Leon E, Abad E, Lledo A, et al. Goal preferences, affect, Activity Patterns and Health Outcomes in Women With Fibromyalgia. Front Psychol. 2019;10:1912.CrossRef Pastor-Mira MA, Lopez-Roig S, Martinez-Zaragoza F, Leon E, Abad E, Lledo A, et al. Goal preferences, affect, Activity Patterns and Health Outcomes in Women With Fibromyalgia. Front Psychol. 2019;10:1912.CrossRef
36.
go back to reference Locke EA, Latham GP. Building a practically useful theory of goal setting and task motivation: a 35-year odyssey. Am Psychol. 2002;57(9):705–17.CrossRef Locke EA, Latham GP. Building a practically useful theory of goal setting and task motivation: a 35-year odyssey. Am Psychol. 2002;57(9):705–17.CrossRef
37.
go back to reference Caneiro JP, Roos EM, Barton CJ, O'Sullivan K, Kent P, Lin I, et al. It is time to move beyond 'body region silos' to manage musculoskeletal pain: five actions to change clinical practice. Br J Sports Med. 2020;54:438–9. Caneiro JP, Roos EM, Barton CJ, O'Sullivan K, Kent P, Lin I, et al. It is time to move beyond 'body region silos' to manage musculoskeletal pain: five actions to change clinical practice. Br J Sports Med. 2020;54:438–9.
38.
go back to reference Meisingset I, Vasseljen O, Vollestad NK, Robinson HS, Woodhouse A, Engebretsen KB, et al. Novel approach towards musculoskeletal phenotypes. Eur J Pain. 2020;24(5):921–32. Meisingset I, Vasseljen O, Vollestad NK, Robinson HS, Woodhouse A, Engebretsen KB, et al. Novel approach towards musculoskeletal phenotypes. Eur J Pain. 2020;24(5):921–32.
Metadata
Title
Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice
Authors
Olav Amundsen
Nina Køpke Vøllestad
Ingebrigt Meisingset
Hilde Stendal Robinson
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-021-04048-4

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