Abstract
Purpose of the study: The aim of this ongoing research is to develop and utilise an individualised, patient-centred approach to outcome measurement in LBP. Specifically, we aim to develop an assessment tool capable of defining “clinically meaningful change” within each patient.
Background: Much work has been dedicated to identifying a definition of successful outcome in LBP. A consensus meeting suggested that 5 discrete domains merit measurement (back specific function, generic health status, pain, work disability and patient satisfaction). Validated tools exist which measure each of these domains. However, how to define what constitutes a “clinically meaningful improvement” as distinct from a “statistically significant change” remains problematic.
Patient satisfaction has been identified as a key dimension in the assessment of outcome in LBP. However what outcome is important to the patient is often not considered, or is poorly assessed. Goal Attainment Scaling (GAS) is a method for systematically targeting individualised goals, and quantifying their achievement. This will provide a valid outcome measure of genuine importance to the patient.
Methods: A semi-structured interview is being developed around the principles of GAS, but specifically modified to elicit patient identified individualised goals that incorporate a marker of “minimum important change” within each scale.
Results: Pilot work has shown that patients can identify meaningful individual goals, which will serve as individualised outcome measures. Furthermore, the notion of achieving a “minimum important change” based around these concepts and within these target scales appears to be generally understood.
Conclusions: Development of an individualised assessment tool capable of defining “clinically meaningful change” within each patient is ongoing. Future work will focus on identifying associations between this individualised outcome and other widely used measures in LBP research, and in establishing the clinical practicality of this approach for use in treatment trials.
The abstracts were prepared by Editorial Secretary, Dr Charles Pither. Correspondence should be addressed to SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
