Patient Expectations as Predictors of Outcome In Patients with Acute Low Back Pain

• Published in: Journal of general internal medicine : JGIM 2008-02, Vol.23 (2), p.148-153
• Main Authors: Myers, Samuel S., Phillips, Russell S., Davis, Roger B., Cherkin, Daniel C., Legedza, Anna, Kaptchuk, Ted J., Hrbek, Andrea, Buring, Julie E., Post, Diana, Connelly, Maureen T., Eisenberg, David M.
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Back pain; Biological and medical sciences; Clinical outcomes; Decision Making; Diseases of the osteoarticular system; Diseases of the spine; Expectations; Female; General aspects; Health Knowledge, Attitudes, Practice; Humans; Internal Medicine; Low Back Pain - psychology; Low Back Pain - rehabilitation; Low Back Pain - therapy; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; Original; Original Article; Pain Measurement; Patient Satisfaction; Preferences; Public health. Hygiene; Public health. Hygiene-occupational medicine; Severity of Illness Index; Treatment Outcome
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-007-0460-5

BACKGROUND Few studies have evaluated the association between patient expectations for recovery and clinical outcomes, and no study has evaluated whether asking patients to choose their therapy modifies such an association. OBJECTIVE To evaluate the association between patients’ expectations and functional recovery in patients with acute low back pain (LBP), and to determine whether that association is affected by giving patients choice of therapy. DESIGN AND PARTICIPANTS A secondary analysis of a randomized controlled trial comparing usual care alone to usual care plus choice of chiropractic, acupuncture, or massage in 444 adults with acute LBP, lasting less than 21 days. MEASUREMENTS AND MAIN RESULTS Primary outcome was functional disability (Roland score) at 5 and 12 weeks. Patients’ general expectations for improvement were associated with improvement in functional status (β = 0.96, 95% CI = 0.56, 1.36). A 1-point increase in general expectations was associated with a 0.96-point improvement in Roland score. The association of expectation with outcome was 2–3 times greater in the usual care group than the choice group. However, these differences did not reach statistical significance. CONCLUSIONS In patients with acute LBP, higher expectations for recovery are associated with greater functional improvement. Eliciting patient expectations for improvement may be a simple way to identify patients with the highest (or lowest) likelihood of experiencing functional improvement. Incorporating questions about patient expectations in future trials may clarify the role of this important correlate of clinical outcomes.