Use of a goal setting intervention to increase adherence to low back pain rehabilitation: a randomized controlled trial

Abstract

Objective:

To examine the effects of a goal setting intervention on self-efficacy, treatment efficacy, adherence and treatment outcome in patients undergoing low back pain rehabilitation.

Design:

A mixed-model 2 (time) × 3 (group) randomized controlled trial.

Setting:

A residential rehabilitation centre for military personnel.

Subjects:

UK military personnel volunteers (N = 48); mean age was 32.9 (SD 7.9) with a diagnosis of non-specific low back pain.

Interventions:

Subjects were randomly assigned to either a goal setting experimental group (Exp, n = 16), therapist-led exercise therapy group (C1, n = 16) or non-therapist-led exercise therapy group (C2, n = 16). Treatment duration for all groups was three weeks.

Main measures:

Self-efficacy, treatment efficacy and treatment outcome were recorded before and after the treatment period. Adherence was rated during regularly scheduled treatment sessions using the Sports Injury Rehabilitation Adherence Scale (SIRAS). The Biering-Sørensen test was used as the primary measure of treatment outcome.

Results:

ANCOVA results showed that adherence scores were significantly higher in the experimental group (13.70 ± 1.58) compared with C2 (11.74 ± 1.35), (P < 0.025). There was no significant difference for adherence between the experimental group and C1 (P = 0.13). Self-efficacy was significantly higher in the experimental group compared to both C1 and C2 (P < 0.05), whereas no significant difference was found for treatment efficacy. Treatment outcome did not differ significantly between the experimental and two control groups.

Conclusions:

The findings provide partial support for the use of goal setting to enhance adherence in clinical rehabilitation.

Keywords

Exercise therapy performance profiling self-efficacy treatment efficacy

Get full access to this article

View all access options for this article.

References

Levack

Taylor

Siegert

. Is goal planning in rehabilitation effective? A systematic review. Clin Rehabil 2006; 20: 739–755.

Siegert

Taylor

. Theoretical aspects of goal-setting and motivation in rehabilitation. Disabil Rehabil 2004; 26: 1–8.

Scobbie

Wyke

Dixon

. Identifying and applying psychological theory to setting and achieving rehabilitation goals. Clin Rehabil 2009; 23: 321–333.

Playford

Siegert

Levack

. Areas of consensus and controversy about goal setting in rehabilitation: a conference report. Clin Rehabil 2009; 23: 334–344.

Bassett

Petrie

. The effect of treatment goals on patient compliance with physiotherapy exercise programmes. Physiotherapy 1999; 85: 130–137.

Locke

Latham

. Building a practically useful theory of goal setting and task motivation. A 35-year odyssey. Am Psychol 2002; 57: 705–717.

Bandura

. Health promotion from the perspective of social cognition theory. In: Norman

Abraham

Connor

(eds) Understanding and changing health behaviour: from health benefits to self-regulation. Reading: Harwood Academic Publishers, 2000.

Schwartzer

Ziegelmann

Luszczynska

. Social-cognitive predictors of physical exercise adherence: three longitudinal studies in rehabilitation. Health Psychol 2008; 27: S54–S63.

Evans

Hardy

. Injury rehabilitation: a goal-setting intervention study. Res Q Exerc Sport 2002; 73: 310–319.

10.

Brewer

Cornelius

van Raalte

. Preliminary psychometric evaluation of a measure of adherence to clinic-based sport injury rehabilitation. Phys Ther Sport 2000; 1: 68–74.

11.

Pizarri

Taylor

McBurney

. Adherence to rehabilitation after anterior cruciate ligament reconstructive surgery: implications for outcome. J Sport Rehabil 2005; 14: 201–214.

12.

Taylor

May

. Threat and coping appraisal as determinants of compliance with sports injury rehabilitation: an application of protection motivation theory. J Sports Sci 1996; 14: 471–482.

13.

Milne

Hall

Forwell

. Self-efficacy, imagery use, and adherence to rehabilitation by injured athletes. J Sport Rehabil 2005; 14: 150–167.

14.

Duda

Smart

Tappe

. Predictors of adherence in the rehabilitation of athletic injuries: an application of personal investment theory. J Sport Exerc Psychol 1989; 11: 367–381.

15.

Brewer

Avondoglio

Cornelius

. Construct validity and interrater agreement of the sport injury rehabilitation adherence scale. J Sport Rehabil 2002; 11: 170–178.

16.

Brewer

Cornelius

van Raalte

. Protection motivation theory and adherence to sport injury rehabilitation revisited. Sport Psychol 2003; 17: 95–103.

17.

Kelly

. The psychology of personal constructs. New York: Norton, 1955.

18.

Annesi

. Goal-setting protocol in adherence to exercise by Italian adults. Percep Mot Skills 2002; 94: 453–458.

19.

Gucciardi

Gordon

. Construing the athlete and exerciser: research and applied perspectives from personal construct psychology. J Appl Sport Psychol 2009; 21: S17–S33.

20.

Butler

. The performance profile: Developing elite performance. London: British Olympic Association Publishing, 1991.

21.

Doyle

Parfitt

. Performance profiling and predictive validity. J Appl Sport Psychol 1996; 8: 160–170.

22.

Friedrich

Gittler

Arendasy

. Long-term effect of a combined exercise and motivational programme on the level of disability of patients with chronic low back pain. Spine 2005; 9: 995–1000.

23.

Friedrich

Gittler

Halberstadt

. Combined exercise and motivation program: effect on the compliance level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Rehabil 1998; 79: 475–487.

24.

Göhner

Schlicht

. Preventing chronic low back pain: Evaluation of a theory-based cognitive-behavioural training programme for patients with sub-acute back pain. Patient Educ Couns 2006; 64: 87–95.

25.

Göhner

Selbaständiges

. Adherence to physiotherapy: a sport motivation model as predictor of exercise compliance in physiotherapy patients. Psychol Sport 2001; 8: 3–18.

26.

World Medical Organization. Declaration of Helsinki. BMJ 1996; 313(7070): 1448–1449.

27.

Kolt

Brewer

Pizzari

. The sport injury rehabilitation adherence scale: a reliable scale for use in clinical physiotherapy. Physiotherapy 2007; 17–22.

28.

Wilson

Rodgers

. The relationship between perceived autonomy support, exercise regulations and behavioural intentions in women. Psychol Sports Exerc 2004; 5: 229–242.

29.

Tabachnick

Fidell

. Using multivariate statistics, fifth edition. Boston: Allyn and Bacon, 2006, pp. 322–390.

30.

Biering-Sorensen

. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine 1983; 9: 106–119.

31.

Leetun

Ireland

Wilson

. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc 2004; 36: 926–934.

32.

McGill

Childs

Liebenson

. Endurance times for low back stabilization for testing and training from a normal database. Arch Phys Med Rehabil 1999; 80: 941–944.

33.

Brewer

. Adherence to sport injury rehabilitation programs. J Appl Sport Psychol 1998; 10: 70–82.

34.

Markland

. The behavioural regulation in exercise questionnaire 2 (BREQ-2). University of Wales, School of Sport and Exercise Sciences. http://www.bangor.ac.uk/~pes004/exercise motivation/scales.htm (accessed 7 June 2007).

35.

Ingledew

Markland

Sheppard

. Personality and self-determination of exercise behaviour. Pers Indiv Differ 2004; 36: 1921–1932.

36.

Cohen J. Statistical power analysis for the behavioural sciences, second edition. New York: Academic Press, 1998, pp. 20–26 and 380–390.

37.

Spetch

Kolt

. Adherence to sport injury rehabilitation: implications for sports medicine providers and researchers. Phys Ther Sport 2001; 2: 80–90.

38.

Levy

Polman

RCJ

Clough

. Adherence to sport injury rehabilitation programs: an integrated psycho-social approach. Scand J Med Sci Sports 2008; 18: 798–809.

39.

Mannion

Helbling

Pulkovski

Sprott

. Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome. Eur Spine J 2009; 18: 1881–1891.

40.

Levy

Polman

RCJ

Nicholls

Marchant

. Sport injury rehabilitation adherence: perspectives of recreational athletes. Int J Sport Exerc Psychol 2009; 7: 212–229.

41.

Bandura

. Toward a unifying theory of behavioural change. Psychol Rev 1977; 84: 191–215.

42.

Weiss

. Psychological aspects of sport-injury rehabilitation: a development perspective. J Athlete Train 2003; 38: 172–175.

43.

Shultz

Chalmers

Hayes

. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995; 273: 408–412.

44.

Pisters

Veenhof

de Bakker

DH.

. Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis: a cluster-randomized trial. J Physiother 2010; 56: 41–47.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

1.01 MB