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The Impact of Personal Functional Goal Achievement on Patient Satisfaction With Progress One Year Following Completion of a Functional Restoration Program for Chronic Disabling Spinal Disorders

Hazard, Rowland G. MD*†; Spratt, Kevin F. PhD; McDonough, Christine M. PT, PhD; Carayannopoulos, A G. DO, MPH; Olson, Colleen M. MS, ARNP*; Reeves, Virginia OT*; Sperry, M L. DPT*; Ossen, Elizabeth S. MSW*

doi: 10.1097/BRS.0b013e3181a9e640
Health Services Research

Study Design. This prospective cohort study investigated personal goal achievement and satisfaction with progress in patients with chronic disabling spinal disorders (CDSD).

Objective. This study examined the relationships between satisfaction with progress and several alternative outcome measures for CDSD patients at least 1 year after completing a functional restoration program (FRP).

Summary of Background Data. Treatment outcome measures for CDSD commonly include pain, physical capacities, and functional/vocational status. These factors are weakly correlated and may not reflect individual patients’ perspectives and priorities.

Methods. On enrollment in the FRP, patients’ pretreatment functional, work, and recreation goals were recorded. Pre- and end-of-program clinical measures included: pain, disability, fear avoidance, lifting, trunk flexibility, and treadmill endurance. At least 1 year after program completion surveys were mailed to consecutive FRP graduates. Nonresponders were surveyed by telephone when possible. Surveys included each patient’s personal pretreatment goals, and assessed Average Pain, SF-36 Physical Function, and satisfaction “with the progress made with your pain problem.” Each patient indicated levels of importance and achievement for each personal goal, and these scores were integrated to yield a goal achievement score (GAS). Linear regression was used to test the relationships between 1-year satisfaction with progress and the following variables: baseline to end-of-program change in clinical measures, and 1-year pain, physical function, and GAS.

Results. Of the 106 surveys mailed, 89 (84%) were returned and 86 (81%) had complete data for analysis. None of the pre-post-program clinical measures was significantly correlated with satisfaction (overall R 2 = 0.013, P < 0.74). In contrast, year-end Average Pain (R 2 = 0.28), Physical Function (R 2 = 0.29), and GAS (R 2 = 0.29) were each significantly correlated (P < 0.0001) with satisfaction, with a combined R 2 = 0.43, P < 0.0001. Of these variables, GAS had the highest unique contribution to satisfaction.

Conclusion. For CDSD patients 1 year after completing rehabilitation, compared to more traditional outcomes, GAS provided the greatest unique contribution to patient satisfaction. Goal achievement may be a valuable patient-centered measure of treatment outcome.

This prospective study of patients with chronic disabling spinal disorders at least 1 year after completing a functional restoration program examined the associations between satisfaction with progress and personal functional goal achievement versus more traditional outcomes. Compared to pain and physical function outcomes, goal achievement scores provided greater unique contribution to patient satisfaction.

From the *Department of Orthopaedic Surgery, The Spine Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; †The Multi-Disciplinary Clinical Research Center in Musculoskeletal Diseases, Dartmouth Medical School, Lebanon, NH; and ‡Department of Neurosurgery, Lahey Clinic, Spine Center, Burlington, MA.

Supported by NIAMS (P60-AR048094) and NICHD (1F32HD056763).

Acknowledgment date: June 10, 2008. Revision date: February 1, 2009. Acceptance date: March 9, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Rowland G. Hazard, MD, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.