Goal conflict in chronic pain: day reconstruction method.
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ABSTRACT:
SUBMITTER: Claes N
PROVIDER: S-EPMC6098675 | biostudies-literature | 2018
REPOSITORIES: biostudies-literature
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Goal conflict in chronic pain: day reconstruction method.
Claes Nathalie N Vlaeyen Johan W S JWS Lauwerier Emelien E Meulders Michel M Crombez Geert G
PeerJ 20180815
<h4>Background</h4>When suffering from chronic pain, attempts to control or avoid pain often compete with other daily activities. Engaging in one activity excludes engaging in another, equally valued activity, which is referred to as "goal conflict." As yet, the presence and effects of goal conflicts in patients with chronic pain remain poorly understood.<h4>Methods</h4>This study systematically mapped the presence and experience of goal conflicts in patients with fibromyalgia compared to health ...[more]
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Project description:Although the adverse effects of chronic pain on work productivity and daily life pursuits are clear, the within-person dynamics of pain, goal cognition, and engagement in work-related and lifestyle goals remain uncharted. This study investigated the impact of pain intensity (assessed on 3 occasions each day) and goal-related schematic thinking (ratings of importance, planning, and goal pursuit opportunities, assessed only in the morning) on afternoon and evening work and lifestyle goal pursuit.A community sample of working adults with chronic pain (N = 131) were screened and interviewed about their work and lifestyle goals and completed a 21-day telephonic diary. Hierarchical linear modeling was used to estimate within-person and between-person effects.At the within-person level, morning pain intensity was inversely related to schematic cognition concerning work and lifestyle goals, whereas, at the between-person level, morning pain intensity varied positively with schematic thinking about work goals as well with afternoon lifestyle goal pursuit. At both the between- and within- analytic levels, morning goal schemas were positively associated with the pursuit of each type of goal in the afternoon and again in the evening. Moreover, positive carry-over effects of morning goal schemas on next day afternoon goal pursuit were observed.Whereas morning pain intensity exhibited inconsistent effects across analytic levels, morning goal-related schematic thinking consistently predicted goal pursuit across analytic levels, type of goal, and time of day. These findings have implications for treatment and prevention of pain's potentially deleterious effects on workplace and lifestyle goals.
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Project description:BackgroundPatient engagement in decisions regarding their health care may lead to improved outcomes and improved adherence to treatment plans. While there are several options for involving patients in their health care, goal setting is a readily accessible method for physical therapists to increase the involvement of patients in health care decisions. Physical therapy goals are often generated by health care providers based on subjective information or standardized, fixed-item, patient-reported outcome measures. However, these outcome measures may not fully reveal the activity and participation limitations of individual patients. Goal attainment scaling (GAS) is a patient-centered approach that allows patients to set meaningful goals. While GAS has been shown to be reliable, valid, and sensitive to change in various populations, there is limited evidence in the United States on utilizing GAS in physical therapy for patients with chronic low back pain (LBP).ObjectiveThe purpose of this paper is to describe the protocol for a study to (1) develop a way to apply GAS procedures for physical therapists treating patients with chronic LBP in the United States and (2) test the feasibility of applying GAS procedures for chronic LBP in an outpatient physical therapy setting.MethodsThis study used a mixed methods design with 2 phases: qualitative and quantitative. The qualitative phase of the study employed focus groups of patients with chronic LBP to identify an inventory of goals that were important and measurable. A series of prompts was developed from this inventory to assist physical therapists in collaboratively establishing goals with patients in a clinical setting. The quantitative phase of the study pilot-tested the inventory developed in the qualitative phase in patients with chronic LBP to determine feasibility, reliability, validity, and responsiveness. We also plan to compare how well GAS reveals change over time relative to traditional, fixed-item, patient-reported measures.ResultsPhase 1 data collection was completed in June 2020, while data collection for phase 2 was performed between March 2021 and December 2021. We anticipate that this study will demonstrate that GAS can be implemented successfully by outpatient physical therapists, and that it will demonstrate clinically important changes in patients with chronic LBP.ConclusionsGAS represents an opportunity for patient-centered care in the physical therapy management of chronic LBP. While GAS is not new, it has never been studied in real-world physical therapy for chronic LBP in a clinical setting. Due to unique time and productivity constraints, for GAS to be successfully implemented in this environment, we must demonstrate that clinicians can be trained efficiently and reliably, that GAS can be implemented in a clinical setting in under 15 minutes, and that GAS is able to detect clinically meaningful changes in patient outcomes.International registered report identifier (irrid)DERR1-10.2196/32457.
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