What does minimal important change mean to patients? Associations between individualized goal attainment scores and disability, general health status and global change in condition

Rationale, aims and objectives In previous work we described a modified version of goal scaling, which enabled patients to identify a meaningful change in their condition within important areas of their lives affected by low back pain. The aim of this study was to explore the associations between goal attainment scores and disability, general health and global change in condition, with particular reference to minimal important change. Methods This was an observational cohort study. Patients attending a multidisciplinary clinic to manage unresolving acute low back pain were interviewed using the modified goal scaling schedule, completed the Roland-Morris Disability Questionnaire and rated their general health status. They were reassessed at 3 and 6 months. Results Thirty-five patients were recruited. Minimal important change was identified on 67% of the goals. At follow-up, goal attainment scores were able to distinguish between 'improvers' and 'non-improvers', and these categories showed significant agreement with change in disability (Kappa = 0.865). Goal attainment was highly correlated with satisfaction (Spearman's rho = 0.88) and moderately associated with general health status (Spearman's rho = 0.40). Conclusions The modified version of Goal Attainment Scaling used here may provide useful additional information about both the problems associated with, and the progress of patients who consult with low back pain in Primary Care.