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Published in: BMC Musculoskeletal Disorders 1/2024

Open Access 01-12-2024 | Back Pain | Research

Goal setting in people with low back pain attending an education and exercise program (GLA:D Back) and the impact of demographic factors

Authors: Mette H.M. Gregersen, Kristine R. Nielsen, Nana H. Lynge, Bibi D. Heiberg, Jan Hartvigsen, Greg Kawchuk, Alice Kongsted

Published in: BMC Musculoskeletal Disorders | Issue 1/2024

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Abstract

Background

Individual goal setting is a fundamental element in self-management supportive interventions, serving to guide actions and enhance motivation for engagement. Despite this, little is known about the goals people with back pain have and to what extent these differ across genders, age groups and geographical location. This study aimed to elucidate this by first describing individual goals set by Danish and Canadian participants in a self-management intervention for people with back pain using the ICF framework; then, determining what proportion of these goals met criteria for being specific, measurable, acceptable, and time bound, and finally, by investigating differences between countries, sexes, and age groups.

Methods

In a cross-sectional study conducted August 2018 to June 2020, 394 Danish and 133 Canadian (Alberta Province) participants defined their individual goals of participating in a self-management programme involving patient education and supervised exercises. The goals were linked to the ICF framework. Distribution of goals was compared between countries, sexes, and age groups.

Results

Goals most often related to the ICF component of ‘Activity and Participation’. The most prevalent goals were “Walking” (DK: 20%; CA: 15%) and “Maintaining a body position” (DK: 17%; CA: 22%). Only few goals differed between populations, age and sex. All elements of SMART goal setting were recorded for 88% of Danish and 94% of Alberta participants.

Conclusions

People with low back pain attending a self-management programme established goals according to the SMART criteria and focused primarily on activity. Goals were similar across countries and showed few differences across sex and age groups. The high number of different goals points to the need for individualised person-centred care.
Literature
1.
go back to reference Global regional. National disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of Disease Study 2017. Lancet. 2018;392(10159):1859–922.CrossRef Global regional. National disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of Disease Study 2017. Lancet. 2018;392(10159):1859–922.CrossRef
2.
go back to reference Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356–67.CrossRefPubMed Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356–67.CrossRefPubMed
3.
go back to reference Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. 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(2):79–86.CrossRefPubMed Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. 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(2):79–86.CrossRefPubMed
4.
go back to reference Corp N, Mansell G, Stynes S, Wynne-Jones G, Morsø L, Hill JC, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: a systematic review of guidelines. Eur J Pain. 2021;25(2):275–95.CrossRefPubMed Corp N, Mansell G, Stynes S, Wynne-Jones G, Morsø L, Hill JC, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: a systematic review of guidelines. Eur J Pain. 2021;25(2):275–95.CrossRefPubMed
5.
go back to reference Schulman-Green D, Jaser S, Martin F, Alonzo A, Grey M, McCorkle R, et al. Processes of self-management in chronic illness. J Nurs Scholarsh. 2012;44(2):136–44.CrossRefPubMedPubMedCentral Schulman-Green D, Jaser S, Martin F, Alonzo A, Grey M, McCorkle R, et al. Processes of self-management in chronic illness. J Nurs Scholarsh. 2012;44(2):136–44.CrossRefPubMedPubMedCentral
6.
go back to reference Allegrante JP, Wells MT, Peterson JC. Interventions to support behavioral self-management of Chronic diseases. Annu Rev Public Health. 2019;40:127–46.CrossRefPubMedPubMedCentral Allegrante JP, Wells MT, Peterson JC. Interventions to support behavioral self-management of Chronic diseases. Annu Rev Public Health. 2019;40:127–46.CrossRefPubMedPubMedCentral
7.
go back to reference Riegel B, Westland H, Iovino P, Barelds I, Bruins Slot J, Stawnychy MA, et al. Characteristics of self-care interventions for patients with a chronic condition: a scoping review. Int J Nurs Stud. 2021;116:103713.CrossRefPubMed Riegel B, Westland H, Iovino P, Barelds I, Bruins Slot J, Stawnychy MA, et al. Characteristics of self-care interventions for patients with a chronic condition: a scoping review. Int J Nurs Stud. 2021;116:103713.CrossRefPubMed
8.
go back to reference Eisele A, Schagg D, Krämer LV, Bengel J, Göhner W. Behaviour change techniques applied in interventions to enhance physical activity adherence in patients with chronic musculoskeletal conditions: a systematic review and meta-analysis. Patient Educ Couns. 2019;102(1):25–36.CrossRefPubMed Eisele A, Schagg D, Krämer LV, Bengel J, Göhner W. Behaviour change techniques applied in interventions to enhance physical activity adherence in patients with chronic musculoskeletal conditions: a systematic review and meta-analysis. Patient Educ Couns. 2019;102(1):25–36.CrossRefPubMed
9.
go back to reference Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.CrossRefPubMed Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.CrossRefPubMed
10.
go back to reference Kongsted A, Ris I, Kjaer P, Hartvigsen J. Self-management at the core of back pain care: 10 key points for clinicians. Braz J Phys Ther. 2021;25(4):396–406.CrossRefPubMedPubMedCentral Kongsted A, Ris I, Kjaer P, Hartvigsen J. Self-management at the core of back pain care: 10 key points for clinicians. Braz J Phys Ther. 2021;25(4):396–406.CrossRefPubMedPubMedCentral
11.
go back to reference Knittle K, Nurmi J, Crutzen R, Hankonen N, Beattie M, Dombrowski SU. How can interventions increase motivation for physical activity? A systematic review and meta-analysis. Health Psychol Rev. 2018;12(3):211–30.CrossRefPubMed Knittle K, Nurmi J, Crutzen R, Hankonen N, Beattie M, Dombrowski SU. How can interventions increase motivation for physical activity? A systematic review and meta-analysis. Health Psychol Rev. 2018;12(3):211–30.CrossRefPubMed
12.
go back to reference Deci EL, Ryan RM. The what and why of goal pursuits: human needs and the self-determination of Behavior. Psychol Inq. 2000;11(4):227–68.CrossRef Deci EL, Ryan RM. The what and why of goal pursuits: human needs and the self-determination of Behavior. Psychol Inq. 2000;11(4):227–68.CrossRef
13.
go back to reference Gardner T, Refshauge K, McAuley J, Hübscher M, Goodall S, Smith L. Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial. Br J Sports Med. 2019;53(22):1424–31.CrossRefPubMed Gardner T, Refshauge K, McAuley J, Hübscher M, Goodall S, Smith L. Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial. Br J Sports Med. 2019;53(22):1424–31.CrossRefPubMed
14.
go back to reference Willett M, Duda J, Fenton S, Gautrey C, Greig C, Rushton A. Effectiveness of behaviour change techniques in physiotherapy interventions to promote physical activity adherence in lower limb osteoarthritis patients: a systematic review. PLoS ONE. 2019;14(7):e0219482.CrossRefPubMedPubMedCentral Willett M, Duda J, Fenton S, Gautrey C, Greig C, Rushton A. Effectiveness of behaviour change techniques in physiotherapy interventions to promote physical activity adherence in lower limb osteoarthritis patients: a systematic review. PLoS ONE. 2019;14(7):e0219482.CrossRefPubMedPubMedCentral
15.
go back to reference Prior JL, Vesentini G, Michell De Gregorio JA, Ferreira PH, Hunter DJ, Ferreira ML. Health Coaching for Low Back Pain and hip and knee osteoarthritis: a systematic review with Meta-analysis. Pain Med. 2023;24(1):32–51.CrossRefPubMed Prior JL, Vesentini G, Michell De Gregorio JA, Ferreira PH, Hunter DJ, Ferreira ML. Health Coaching for Low Back Pain and hip and knee osteoarthritis: a systematic review with Meta-analysis. Pain Med. 2023;24(1):32–51.CrossRefPubMed
16.
go back to reference Preede LA-O, Soberg HL, Dalen H, Nyquist A, Jahnsen RA-O, Saebu M et al. Rehabilitation Goals and effects of goal achievement on Outcome following an adapted physical activity-based Rehabilitation intervention. 2021(1177-889X (Print)). Preede LA-O, Soberg HL, Dalen H, Nyquist A, Jahnsen RA-O, Saebu M et al. Rehabilitation Goals and effects of goal achievement on Outcome following an adapted physical activity-based Rehabilitation intervention. 2021(1177-889X (Print)).
17.
go back to reference Constand MK, MacDermid JC. Applications of the International Classification of Functioning, Disability and Health in goal-setting practices in healthcare. Disabil Rehabil. 2014;36(15):1305–14.CrossRefPubMed Constand MK, MacDermid JC. Applications of the International Classification of Functioning, Disability and Health in goal-setting practices in healthcare. Disabil Rehabil. 2014;36(15):1305–14.CrossRefPubMed
18.
go back to reference WHO. International classification of functioning, disability and health (ICF). WHO; 2001. WHO. International classification of functioning, disability and health (ICF). WHO; 2001.
19.
go back to reference Amundsen O, Vøllestad NK, Meisingset I, Robinson HS. Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice. BMC Musculoskelet Disord. 2021;22(1):182.CrossRefPubMedPubMedCentral Amundsen O, Vøllestad NK, Meisingset I, Robinson HS. Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice. BMC Musculoskelet Disord. 2021;22(1):182.CrossRefPubMedPubMedCentral
20.
go back to reference Wade DT. Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil. 2009;23(4):291–5.CrossRefPubMed Wade DT. Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil. 2009;23(4):291–5.CrossRefPubMed
21.
go back to reference MacLeod L. Making SMART goals smarter. Physician Exec. 2012;38(2):68–70. 2.PubMed MacLeod L. Making SMART goals smarter. Physician Exec. 2012;38(2):68–70. 2.PubMed
22.
go back to reference Kjaer P, Kongsted A, Ris I, Abbott A, Rasmussen CDN, Roos EM, et al. GLA:D((R)) back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence. BMC Musculoskelet Disord. 2018;19(1):418.CrossRefPubMedPubMedCentral Kjaer P, Kongsted A, Ris I, Abbott A, Rasmussen CDN, Roos EM, et al. GLA:D((R)) back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence. BMC Musculoskelet Disord. 2018;19(1):418.CrossRefPubMedPubMedCentral
23.
go back to reference Kongsted A, Ris I, Kjaer P, Vach W, Morso L, Hartvigsen J. GLA:D((R)) back: implementation of group-based patient education integrated with exercises to support self-management of back pain - protocol for a hybrid effectiveness-implementation study. BMC Musculoskelet Disord. 2019;20(1):85.CrossRefPubMedPubMedCentral Kongsted A, Ris I, Kjaer P, Vach W, Morso L, Hartvigsen J. GLA:D((R)) back: implementation of group-based patient education integrated with exercises to support self-management of back pain - protocol for a hybrid effectiveness-implementation study. BMC Musculoskelet Disord. 2019;20(1):85.CrossRefPubMedPubMedCentral
24.
go back to reference Lemieux J, Kawchuk G, Kongsted A, Hartvigsen J, Abdollah V, Jones A. The feasibility of implementing an English language version of GLA:D back. Pilot Feasibility Stud. 2021;7(1):38.CrossRefPubMedPubMedCentral Lemieux J, Kawchuk G, Kongsted A, Hartvigsen J, Abdollah V, Jones A. The feasibility of implementing an English language version of GLA:D back. Pilot Feasibility Stud. 2021;7(1):38.CrossRefPubMedPubMedCentral
25.
go back to reference Kongsted A, Hartvigsen J, Ris I, Kjaer P, Boyle E, Thomassen L, et al. GLA:D BACK: feasibility of implementing standardized care for back pain through a 2-DAY clinician training course. Osteoarthritis and Cartilage. 2019;27:S445. Kongsted A, Hartvigsen J, Ris I, Kjaer P, Boyle E, Thomassen L, et al. GLA:D BACK: feasibility of implementing standardized care for back pain through a 2-DAY clinician training course. Osteoarthritis and Cartilage. 2019;27:S445.
26.
go back to reference Fehrmann E, Ebenbichler G, Tüchler K, Habenicht R, Mair P, Fischer-Grote L et al. Do the WHO-ICF personal factors age and sex impact limited activity and restricted participation category profiles differently between younger and older women and men in multimodal chronic back pain rehabilitation? Disabil Rehabil. 2022:1–10. Fehrmann E, Ebenbichler G, Tüchler K, Habenicht R, Mair P, Fischer-Grote L et al. Do the WHO-ICF personal factors age and sex impact limited activity and restricted participation category profiles differently between younger and older women and men in multimodal chronic back pain rehabilitation? Disabil Rehabil. 2022:1–10.
27.
go back to reference Rogers CJ, Hackney ME, Zubkoff L, Echt KV. The use of patient-led goal setting in the intervention of chronic low back pain in adults: a narrative review. Pain Manag. 2022;12(5):653–64.CrossRefPubMed Rogers CJ, Hackney ME, Zubkoff L, Echt KV. The use of patient-led goal setting in the intervention of chronic low back pain in adults: a narrative review. Pain Manag. 2022;12(5):653–64.CrossRefPubMed
28.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of Observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–8.CrossRef von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of Observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–8.CrossRef
29.
go back to reference Grønne DTR, Inge.; Kongsted A, Roos E, Hartvigsen J, Skou ST. GLA:D® Danmark Årsrapport 2020 Department of Sports Science and Clinical Biomechanics University of Southern Denmark; 2021. Grønne DTR, Inge.; Kongsted A, Roos E, Hartvigsen J, Skou ST. GLA:D® Danmark Årsrapport 2020 Department of Sports Science and Clinical Biomechanics University of Southern Denmark; 2021.
30.
go back to reference Lemieux J, Kawchuk G, Kongsted A, Hartvigsen J, Abdollah V, Jones A. The feasibility of implementing an English language version of GLA:D Back. (2055–5784 (Print)). Lemieux J, Kawchuk G, Kongsted A, Hartvigsen J, Abdollah V, Jones A. The feasibility of implementing an English language version of GLA:D Back. (2055–5784 (Print)).
31.
go back to reference Kongsted A, Ris I, Boyle E, Kjaer P, Hartvigsen J. Adoption, sustainability, and reach of GLA:D® Back - a structured patient education and exercise program for people with back pain. An observational implementation study. https://gladryg.sdu.dk/; 2022 December. Kongsted A, Ris I, Boyle E, Kjaer P, Hartvigsen J. Adoption, sustainability, and reach of GLA:D® Back - a structured patient education and exercise program for people with back pain. An observational implementation study. https://​gladryg.​sdu.​dk/​; 2022 December.
32.
go back to reference Karhula M, Saukkonen S, Xiong E, Kinnunen A, Heiskanen T, Anttila H. ICF personal factors strengthen commitment to person-centered Rehabilitation - A Scoping Review. Front Rehabil Sci. 2021;2:709682.CrossRefPubMedPubMedCentral Karhula M, Saukkonen S, Xiong E, Kinnunen A, Heiskanen T, Anttila H. ICF personal factors strengthen commitment to person-centered Rehabilitation - A Scoping Review. Front Rehabil Sci. 2021;2:709682.CrossRefPubMedPubMedCentral
33.
go back to reference Cieza A, Fayed N, Bickenbach J, Prodinger B. Refinements of the ICF linking rules to strengthen their potential for establishing comparability of health information. Disabil Rehabil. 2019;41(5):574–83.CrossRefPubMed Cieza A, Fayed N, Bickenbach J, Prodinger B. Refinements of the ICF linking rules to strengthen their potential for establishing comparability of health information. Disabil Rehabil. 2019;41(5):574–83.CrossRefPubMed
36.
go back to reference Lohmann S, Decker J, Muller 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.CrossRefPubMed Lohmann S, Decker J, Muller 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.CrossRefPubMed
37.
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.CrossRefPubMed 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.CrossRefPubMed
38.
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.CrossRefPubMed 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.CrossRefPubMed
39.
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.CrossRefPubMed 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.CrossRefPubMed
40.
go back to reference Cowell I, McGregor A, O’Sullivan P, O’Sullivan K, Poyton R, Schoeb V, et al. Physiotherapists’ approaches to patients’ concerns in Back Pain consultations following a psychologically informed training program. Qual Health Res. 2021;31(13):2486–501.CrossRefPubMedPubMedCentral Cowell I, McGregor A, O’Sullivan P, O’Sullivan K, Poyton R, Schoeb V, et al. Physiotherapists’ approaches to patients’ concerns in Back Pain consultations following a psychologically informed training program. Qual Health Res. 2021;31(13):2486–501.CrossRefPubMedPubMedCentral
41.
go back to reference Lenzen SA, Daniëls R, van Bokhoven MA, van der Weijden T, Beurskens A. Disentangling self-management goal setting and action planning: a scoping review. PLoS ONE. 2017;12(11):e0188822.CrossRefPubMedPubMedCentral Lenzen SA, Daniëls R, van Bokhoven MA, van der Weijden T, Beurskens A. Disentangling self-management goal setting and action planning: a scoping review. PLoS ONE. 2017;12(11):e0188822.CrossRefPubMedPubMedCentral
42.
go back to reference Epton T, Currie S, Armitage CJ. Unique effects of setting goals on behavior change: systematic review and meta-analysis. J Consult Clin Psychol. 2017;85(12):1182–98.CrossRefPubMed Epton T, Currie S, Armitage CJ. Unique effects of setting goals on behavior change: systematic review and meta-analysis. J Consult Clin Psychol. 2017;85(12):1182–98.CrossRefPubMed
43.
44.
go back to reference Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil. 2011;25(6):501–14.CrossRefPubMed Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil. 2011;25(6):501–14.CrossRefPubMed
45.
go back to reference Swann C, Jackman PC, Lawrence A, Hawkins RM, Goddard SG, Williamson O, et al. The (over)use of SMART goals for physical activity promotion: a narrative review and critique. Health Psychol Rev. 2023;17(2):211–26.CrossRefPubMed Swann C, Jackman PC, Lawrence A, Hawkins RM, Goddard SG, Williamson O, et al. The (over)use of SMART goals for physical activity promotion: a narrative review and critique. Health Psychol Rev. 2023;17(2):211–26.CrossRefPubMed
46.
go back to reference Chap. 3—Motivational interviewing as a Counseling Style. Enhancing motivation for change in Substance Use Disorder Treatment: updated 2019 [Internet]. Substance Abuse and Mental Health Services Administration (US); 2019. Chap. 3—Motivational interviewing as a Counseling Style. Enhancing motivation for change in Substance Use Disorder Treatment: updated 2019 [Internet]. Substance Abuse and Mental Health Services Administration (US); 2019.
Metadata
Title
Goal setting in people with low back pain attending an education and exercise program (GLA:D Back) and the impact of demographic factors
Authors
Mette H.M. Gregersen
Kristine R. Nielsen
Nana H. Lynge
Bibi D. Heiberg
Jan Hartvigsen
Greg Kawchuk
Alice Kongsted
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2024
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-024-07450-w

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