Patient led goal setting in chronic low back pain

Patient led goal setting- participants will be facilitated by a physiotherapist to determine problems areas, goals and strategies relevant to their low back pain. Patient led goal setting sessions will be delivered as individual face to face consultations, a total of 8 times: 5 sessions during the first 2 months (one at baseline and 4 sessions at fortnightly intervals) followed by 2 sessions at 1-month intervals. There will be a final session at the 12-month follow-up.Together with the RA, participants randomized to the patient led goal setting group will identify the problems that are most important to them, practical strategies to address each of these problems, and specify desired outcomes. Participants will be given a participant workbook in which they will record their identified issues, and the priority assigned to each. They will record their target goals and the strategies to achieve them, including each step and the timeframe. The workbook will also contain some basic physiology relevant to chronic low back pain, common treatments for symptom control and goal setting guidelines written in simple language. At the conclusion of each visit, the workbook will be copied to enable analysis of the goals and any new identified strategies. The first session: the first session will commence with participants discussing those aspects of their back pain or related health issues that are of greatest personal concern to them. A stimulus list of all prognostic factors (e.g. depression or low mood, lack of physical activity, fear of activity, weight loss, etc) may be used when required. Once identified, participants will prioritise their concerns and the first two will initially be selected for goal-setting. Participants will learn how to transform these concerns into goals, formulate strategies to attain these goals and learn how to set realistic steps. Use of evidence-based or best practice management for each goal will be encouraged. The participant will be asked to carry out the set strategies between sessions. Subsequent visits: The participant and the therapist will review the agreed goals and strategies, and the extent of achievement. Working together, they will determine the need for modification to the goals set, strategies and time frames. The final visit: The therapeutic interaction will conclude at the final visit. The process, strategies undertaken during the intervention period and any other concerns of the participant will be reviewed. Together, the participant and therapist will plan ongoing self-management and review how to make decisions about seeking future health care and possible referral to their primary care practitioner.