Goal scaling for low back pain in primary care: development of a semi-structured interview incorporating minimal...

Goal attainment scaling was an individualized assessment technique developed to evaluate the provision of complex public services. However, this produced a measure which was driven more by the need to demonstrate clinical efficacy rather than reflecting a patient's own aspirations. People with low back pain have problems ranging from functional daily activities to areas which impinge upon their wider role in society and quality of life. Commonly used scales to measure back pain-related disability may not capture domains of relevance to patients. The aim of this project was to develop a goal-based individualized assessment tool capable of defining meaningful change in condition from the patient perspective for use in longitudinal clinical studies.

We developed a semi-structured interview to elicit patient important goals. We refined our initial framework by conducting consecutive rounds of interviews with patients and reviewing the feedback. Within this approach, we included a point identified as the minimum level of change needed within each goal that would be considered a meaningful improvement in condition by the patient.

Fifteen patients with low back pain took part in the study. Three rounds of interviews were held to refine the questions used to develop the goal scales. Overall, the participants identified a total of 59 problem areas, reducing these to the 45 most important goals (three for each patient). The minimal significant improvement was identified on 31 (69%) of these, with all except one patient able to identify this marker on two or more of their goal scales.

The formation of individualized goal scales was successful in all of the participants in this study. Patients were able to understand the concept of 'minimal important change', and identify a specific target to reflect this for two-thirds of their chosen goals.