Happy New Year and welcome back to the SpineIQ Back Blog! This is the time of the year that the majority of people make new year’s resolutions and create specific goals for themselves. Unfortunately, the vast majority of those well-intentioned resolutions wind up being broken. Matter of fact most resolutions fail because people know what they want but not WHY they want it. Lose weight, get fit, exercise, all lofty goals but WHY do you want to do those things is what will enable you to keep those resolutions and the benefits they bring. This is where you as the trusted clinician can help patients to understand the WHY of your advice on healthier living. Goal setting can be a helpful tool in the clinician’s toolbox when treating people experiencing low back pain.1 Goal setting is done through a process that incorporates shared-decision making between the patients and clinician to agree on goals that are important to the patient along with a plan and timeline to achieve those goals.1 For example, patients commonly report that their pain has led to a decrease how active they are and they prioritize returning to previous activity as their goal. Through shared-decision making between the clinician and patient, a plan to find a baseline of activity that is not too bothersome and slowly progress amount of time and intensity towards the desired goal amount. Shared-decision making, patient centered care, and goal setting are recommended in low back pain clinical practice guidelines, however, clinicians commonly report several barriers to incorporating these in routine clinical practice.2 Throughout this blog, we will discuss commonly reported barriers and potential facilitators in using goal setting as treatment for low back pain which has been suggested to have beneficial effects.3
It is important to note that despite numerous barriers reported by clinicians, many clinicians still use goal setting with patients.1 This shows that while there is barriers to goal setting, just like most things, it is possible to overcome them and worth it for the value and benefit. The most common barrier is the perceived amount of time needed in order to use goal setting with patients. Helping to defuse the actual amount of time versus the guessed will go a long way in accomplishing the goal. Additionally, inadequate staffing and a lack of skill/training for the staff in goal setting was reported as a common barrier.
Clinicians that plan in advance the strategies to overcome the barriers are more likely to use goal setting with their patients.1 In order to overcome the barrier of time constraint, there are two main potential facilitators. First, clinicians reported that when involving the patient by allowing them to set and prioritizing the goals, the time needed to use goal setting was less than previously thought. Second, clinicians found that the initial time investment of training staff through role playing allowed the staff to reduce the burden on clinician to perform the goal setting intervention with patients. This up-front effort and awareness will pay huge dividends for patients and staff, as goals become accomplished, and satisfaction grows.
Goal setting is an important, patient centered intervention that can help people experiencing low back pain. The majority of clinicians use goal setting with their patients and do not report barriers. However, some barriers (e.g., time constraint) are reported and facilitators like training staff to perform goal setting are used to overcome those barriers. By helping patients choose and prioritize their goals, clinicians find that the time constraint is minimal, and patients confidently express their needs, values, and expectations that can be used for goal setting.
- Gardner T, Refshauge K, McAuley J, Hübscher 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. doi:10.1080/09593985.2018.1425785
- Lin I, Wiles L, Waller R, 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. doi:10.1136/bjsports-2018-099878
- Henschke N, Ostelo RW, van Tulder MW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;(7):CD002014. doi:10.1002/14651858.CD002014.pub3