Goal Setting Intervention for Chronic Knee Pain

(mGAME Trial)

Overseen By Jiaoyuan Elisabeth Diallo

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Dartmouth-Hitchcock Medical Center

Disqualifiers: Non-English speaking, recent surgeries, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 8 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine how setting specific goals can help people manage chronic knee pain. It will test various methods of developing and tracking goals, such as Goal Attainment Scaling (GAS) and Goal Development, to identify the most effective approach for patients. Individuals dealing with knee issues and scheduled for a consultation with an orthopedic surgeon may be suitable candidates for this trial. Participants will focus on creating clear, actionable goals to improve their knee condition. As an unphased trial, this study offers the opportunity to explore innovative goal-setting techniques to enhance knee health.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this goal setting intervention is safe for chronic knee pain?

Research has shown that setting goals, as in this study, is generally safe for people. One study found that participants felt more satisfied with their progress and did not report any major negative effects. This suggests that setting and tracking goals can be a positive experience without serious risks.

For creating goals, past participants found these methods easy to use and acceptable, indicating they faced no major problems. This aligns with findings that when patients set their own goals, it can enhance their overall treatment experience.

Regarding tracking goals, clinical trials have shown that using activity trackers works well. Patients used these tools without major issues, supporting their safety in tracking progress.

Overall, these methods focus on setting, achieving, and tracking goals, which participants generally receive well. Available research shows no clear evidence of negative effects from these methods. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores a unique approach to managing chronic knee pain through goal-setting techniques. Unlike traditional treatments, which often focus on medications or physical therapy, this trial emphasizes personal goal development and tracking to empower patients in managing their pain. The intervention is designed to help patients set and achieve personalized goals, potentially leading to improved motivation and adherence to self-management strategies. By involving patients actively in their treatment, this method could offer a more personalized and sustainable approach to pain management.

What evidence suggests that this trial's interventions could be effective for chronic knee pain?

Research has shown that setting personalized goals can effectively manage chronic knee pain. In this trial, participants will engage in different interventions focused on goal setting. One group will participate in the Goal Attainment Intervention, which uses Goal Attainment Scaling (GAS), a method that has increased satisfaction with work activities for people with chronic pain. Another group will take part in the Goal Development and Tracking Intervention, emphasizing the development and tracking of personalized goals. In one study, more than half of the participants reached their goals for improving daily activities within three months, suggesting that clear, specific goals can lead to real improvements in everyday life. Tracking progress can enhance pain management by revealing what works and what doesn’t. Overall, these methods appear promising for better managing knee pain. ^{1 3 6 7 8}

Who Is on the Research Team?

Kevin J McGuire, MD

Principal Investigator

Dartmouth-Hitchcock Medical Center

Are You a Good Fit for This Trial?

This trial is for adults over 21 who are new or existing patients scheduled to see an orthopaedic surgeon for knee issues. It's not open to those unable to consent, non-English speakers, or anyone less than a year out from prior spine, hip, or knee surgery.

Inclusion Criteria

I am 21 years old or older.

I am scheduled for a knee consult with an orthopaedic surgeon for a new issue.

Exclusion Criteria

I can consent and complete surveys without help.

I had knee surgery less than a year ago, spine surgery less than 6 months ago, or another knee/hip surgery less than 3 months ago.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo the goal development intervention to identify high quality, specific, measurable, relevant, and time-bound goals for treatment

8 months

Follow-up

Participants are monitored for the effectiveness of the goal development intervention and shared decision making

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Goal Attainment
• Goal Development
• Goal Tracking

Trial Overview The study tests a goal development intervention that helps patients set and track specific and measurable goals for their knee treatment. The effectiveness of this personalized approach will be evaluated.

How Is the Trial Designed?

Group I: Goal Development and Tracking Intervention Active Control 2 Interventions

Group II: Goal Attainment Intervention Active Control 1 Intervention

Group III: Goal Development Intervention Active Control 1 Intervention

Who Is Running the Clinical Trial?

Dartmouth-Hitchcock Medical Center

Lead Sponsor

Trials

548

Recruited

2,545,000+

Medacta USA

Industry Sponsor

Trials

17

Recruited

2,100+

Published Research Related to This Trial

In a study involving 17 older adults (average age 79) with arthritis, 76% successfully set and achieved their individual pain management goals through the Goal Attainment Pain Management Program (GAPMAP).

Participants reported increased use and effectiveness of pain management methods, particularly exercise and heated water therapies, leading to significant improvements in their experience of persistent pain and expectations for pain management outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A goal attainment pain management program for older adults with arthritis. Davis, GC., White, TL.[2022]

In a study involving 20 participants with chronic low back pain, patients identified 27 unique goals, primarily focused on physical activity, which were largely misaligned with standard clinical outcome measures used by physiotherapists.

The findings suggest that 76% of patient goals aligned with physical functioning outcomes recommended by the IMMPACT consortium, indicating that current clinical measures may not accurately reflect what is meaningful to patients, highlighting the need for a more collaborative approach in treatment planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient led goal setting in chronic low back pain-What goals are important to the patient and are they aligned to what we measure? Gardner, T., Refshauge, K., McAuley, J., et al.[2019]

In a study involving 149 patients in a 15-day chronic pain management program, Goal Attainment Scaling (GAS) demonstrated significant improvements, indicating its effectiveness as a therapeutic tool for achieving personalized goals in rehabilitation.

Patients maintained their improvements in GAS and other measures like pain intensity and disability at a six-month follow-up, suggesting that GAS is a valid and reliable outcome measure for assessing long-term benefits of rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Goal attainment scaling in evaluating a multidisciplinary pain management programme. Fisher, K., Hardie, RJ.[2017]

A new individualized assessment tool was developed to better capture meaningful changes in low back pain from the patient's perspective, involving 15 patients who identified 45 important goals related to their condition.

The majority of participants (69%) were able to define a 'minimal important change' for their goals, demonstrating that patients can effectively engage in setting targets for their recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Goal scaling for low back pain in primary care: development of a semi-structured interview incorporating minimal important change. Mullis, R., Hay, EM.[2021]

Goal attainment scaling (GAS) has been shown to be a feasible and patient-centered approach for individuals with low back pain (LBP), allowing patients to set personalized goals during rehabilitation.

GAS may be more sensitive to changes in patient outcomes compared to traditional fixed-item measures, suggesting it could enhance patient satisfaction and therapeutic effects, although it still requires further development and validation for effective use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Goal attainment scaling for patients with low back pain in rehabilitation: A systematic review. Haladay, D., Swisher, L., Hardwick, D.[2022]

The biopsychosocial approach to chronic pain management can be enhanced by using Goal Attainment Scaling (GAS), which allows for individualized and measurable treatment goals tailored to each patient's unique experience of pain.

GAS has been effectively applied in various contexts, including cancer pain and pediatric pain, making it a valuable tool for guiding treatment planning and evaluating the effectiveness of chronic pain programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The application of goal attainment scaling in chronic pain settings. Zaza, C., Stolee, P., Prkachin, K.[2019]

Goal Attainment Scaling (GAS) is an effective tool for measuring client outcomes in rural and remote health services, allowing for individualized goal setting on a five-point scale.

GAS promotes collaboration between clinicians and clients, making it easier to summarize diverse service outcomes and ensuring that goals remain relevant and realistic.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Goal attainment scaling: an effective outcome measure for rural and remote health services. Cox, R., Amsters, D.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9586611/

From individualised treatment goals to personalised ... In patients with osteoarthritis, the Goal Attainment Scale instrument can be used to measure health outcomes at different time points and its ...

2. physio-pedia.com physio-pedia.com/Goal_Attainment_Scaling

Goal Attainment Scaling GAS comprises of goals divided into a 5-point scale from -2 to +2. Achievement of goal = 0; Achieved somewhat more than expected outcome = +1; Achievement of ...

3. sralab.org sralab.org/rehabilitation-measures/goal-attainment-scale

Goal Attainment Scale | RehabMeasures Database The Goal Attainment Scale (GAS) is an individualized outcome measure involving goal selection and goal scaling that is standardized in order to calculated the ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7508269/

Goal Attainment Scaling Rehabilitation Improves ... Personalized, goal-specific rehabilitation using GAS resulted in higher patient satisfaction with work activities, compared with standard rehabilitation, 1 ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S0885392498001067

The Application of Goal Attainment Scaling in Chronic Pain ... Goal Attainment Scaling (GAS) is an individualized health outcome measure with qualities that can fill these gaps. GAS is a clinical and research tool that can ...

6. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1524904208000660

A Goal Attainment Pain Management Program for Older ... The purpose of this study was to test a pain management intervention that integrates goal setting with older adults (age ≥65) living independently in ...

7. bmcmusculoskeletdisord.biomedcentral.com bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-0965-3

Does Goal Attainment Scaling improve satisfaction regarding ... The VAS is a validated, self-reported instrument that can accurately measure patient satisfaction on a scale ranging from 0 to 100, where zero ...

8. journals.sagepub.com journals.sagepub.com/doi/10.1177/0269215508101742

Goal attainment scaling (GAS) in rehabilitation: a practical ... Goal attainment scaling is a mathematical technique for quantifying the achievement (or otherwise) of goals set, and it can be used in rehabilitation.