Goal Identification Before Spinal Cord Stimulation: A Qualitative Exploration in Potential Candidates

Abstract

Introduction Due to the difficulties encountered in the treatment process of patients with chronic pain, it is of utmost importance to involve patients themselves in their rehabilitation trajectory. Patient engagement can be obtained by motivating patients to select their own treatment goals. We hypothesize that applying goal setting, as a form of patient empowerment, in potential candidates for spinal cord stimulation (SCS) may further improve the outcome of SCS. As a first step in creating patient empowerment, patients' goals that they aim to achieve with SCS will be explored. Methods Fifteen patients suffering from failed back/neck surgery syndrome and scheduled for SCS were interviewed in depth. All interviews were audio recorded and analyzed using in vivo coding. Afterwards, the International Classification of Functioning, Disability and Health framework was used to structure the responses of patients. Results In the domain of bodily functions, all patients mentioned pain reduction, and 1 patient wanted to regain his previous sleep pattern. In the domain of activities, walking, sitting, driving a car, bending down, and picking up were the highest ranked goals. Regaining a social life was the highest ranked goal for participation. Eleven patients wanted to regain a feeling of happiness, and 5 patients wanted to focus on avoiding depression. Conclusion The interviews revealed a broad spectrum of individual patients' goals, highlighting the need of individually targeted rehabilitation trajectories in the field of neuromodulation. Goal identification could entail the first step towards individualized medicine in the SCS trajectory.

Long-Term Efficacy of a Novel Spinal Cord Stimulation Clinical Workflow Using Kilohertz Stimulation: Twelve-Month Results From the Vectors Study

“…It is important to consider these when assessing the benefits of SCS. Every patient can present a unique clinical profile extending beyond the direct management of their chronic pain symptoms (29).…”

Views of patients suffering from Failed Back Surgery Syndrome on their health and their ability to adapt to daily life and self-management: A qualitative exploration

“…The absence of goal identification in daily activities might have contributed to disturbing mental well-being [15,23]. In these papers, it is argued that personal goals on physical and psychological levels are associated with an increased mental well-being, satisfaction and quality of care, including: problem disengagement, goal orientation, personal strength, and how the goal may be accomplished [13,19,23].…”

“…However, to develop personal goals, health care professionals should collaborate with a patient for adherence, motivation, and to correctly understand their needs [13,23].…”

“…Earlier studies investigated patients 'experiences after SCS implantation [11], educational needs in FBSS patient [12], and expectations in the period that SCS was planned [10]. One study explored the importance of goal identification before SCS [13].…”

Experiences From the Patient Perspective on Spinal Cord Stimulation for Failed Back Surgery Syndrome: A Qualitatively Driven Mixed Method Analysis

“…It seems reasonable that quality of life-(QoL) and psychosocialrelated factors contribute to the concluding outcome of SCS since pain is a multidimensional experience (7). Several qualitative studies have explored the effects of SCS and the expectations regarding SCS from the patient perspective (8)(9)(10), as well as the identification of outcome goals (11). The selection of such goals is believed to enhance patients' motivation and engagement to achieve their selected outcome parameters (12).…”