What psychological and physical changes predict patients’ attainment of personally meaningful goals six months following a CBT based pain management intervention?

Abstract

Purpose: To examine the influence of demographic measures, and changes in physical ability, pain, self-efficacy and emotional distress on Goal Attainment Scaling (GAS) scores, after a 15-day CBT based pain management programme.

Method: Chronic pain patients (N = 257) were referred; 225 (88%) completed the programme and were invited for follow up six months later. One hundred and sixty-two (63%), (mean age 47.7, 71% female) completed the reassessment procedures. GAS scores (which were also repeated at the end the programme), an 11-point Pain Numerical Rating Scale, Pain Self-Efficacy Questionnaire, Hospital Anxiety and Depression Scale, distance walked in 5 mins, number of sit/stand repetitions in 1 min and number of stairs climbed in 1 min were measured on the first day and six months following the programme.

Results: At six months post discharge, changes in goal attainment, physical measures, pain intensity, depression and self-efficacy were observed. Hierarchical regression showed change in GAS was predicted by improvement in walking tolerance and self-efficacy.

Conclusions: The achievement of personally important goals was most significantly associated with change in walking ability and self-efficacy, while controlling for the influence of change in pain.

Implications for Rehabilitation

• Chronic pain can reduce psychological and physical functioning, leading to a reduction in meaningful activities.

• Achievement of personally important activities as measured by Goal Attainment Scaling can be a more sensitive measure of programme outcome than that captured by many other standard measures.

• Self-efficacy is an important predictor of attainment of patient preferred goals following a CBT based pain management programme, and could be emphasized during treatment along with improved walking ability, to enhance patients’ goal achievement.

Keywords:

• Chronic pain
• Goal Attainment Scaling
• self-efficacy
• Cognitive Behavioral Therapy

Acknowledgements

The authors would like to thank the therapists and the participants who took part in the study.

Disclosure statement

The authors report no conflicts of interest.