Patient expectations as predictors of outcome in patients with acute low back pain

Samuel S. Myers; Russell S. Phillips; Roger B. Davis; Daniel C. Cherkin; Anna Legedza; Ted J. Kaptchuk; Andrea Hrbek; Julie E. Buring; Diana Post; Maureen T. Connelly; David M. Eisenberg

doi:10.1007/s11606-007-0460-5

Patient expectations as predictors of outcome in patients with acute low back pain

Samuel S. Myers, Russell S. Phillips, Roger B. Davis, Daniel C. Cherkin, Anna Legedza, Ted J. Kaptchuk, Andrea Hrbek, Julie E. Buring, Diana Post, Maureen T. Connelly, David M. Eisenberg

Research output: Contribution to journal › Article › peer-review

127 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	148-153
Number of pages	6
Journal	Journal of general internal medicine
Volume	23
Issue number	2
DOIs	https://doi.org/10.1007/s11606-007-0460-5
State	Published - Feb 2008
Externally published	Yes

Bibliographical note

Funding Information:
Funding/Support: The project described was supported by Grant Number 1 R01 AT 00144 from the National Center for Complementary and Alternative Medicine. This work has also been supported in part by a generous endowment from the Bernard Osher Foundation and an unrestricted educational grant from American Specialty Health. Dr. Myers was supported by an Institutional National Research Service Award (T32AT00051-06) from the National Institutes of Health when this research was performed. Dr. Phillips is supported by a Mid-Career Investigator Award from the National Center for Complementary and Alternative Medicine, National Institutes of Health (K24-AT000589). The funding organizations did not provide any input into the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review or approval of the manuscript.

Keywords

Choice
Expectations
Low back pain
Preference
Randomized controlled trial

Publisher link

10.1007/s11606-007-0460-5

Find It

Find It at U of M Libraries

Cite this

@article{daa95069d4a5449fbdbb7cd9deb737fa,

title = "Patient expectations as predictors of outcome in patients with acute low back pain",

abstract = "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.",

keywords = "Choice, Expectations, Low back pain, Preference, Randomized controlled trial",

author = "Myers, {Samuel S.} and Phillips, {Russell S.} and Davis, {Roger B.} and Cherkin, {Daniel C.} and Anna Legedza and Kaptchuk, {Ted J.} and Andrea Hrbek and Buring, {Julie E.} and Diana Post and Connelly, {Maureen T.} and Eisenberg, {David M.}",

note = "Funding Information: Funding/Support: The project described was supported by Grant Number 1 R01 AT 00144 from the National Center for Complementary and Alternative Medicine. This work has also been supported in part by a generous endowment from the Bernard Osher Foundation and an unrestricted educational grant from American Specialty Health. Dr. Myers was supported by an Institutional National Research Service Award (T32AT00051-06) from the National Institutes of Health when this research was performed. Dr. Phillips is supported by a Mid-Career Investigator Award from the National Center for Complementary and Alternative Medicine, National Institutes of Health (K24-AT000589). The funding organizations did not provide any input into the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review or approval of the manuscript.",

year = "2008",

month = feb,

doi = "10.1007/s11606-007-0460-5",

language = "English (US)",

volume = "23",

pages = "148--153",

journal = "Journal of General Internal Medicine",

issn = "0884-8734",

publisher = "Springer New York LLC",

number = "2",

}

TY - JOUR

T1 - Patient expectations as predictors of outcome in patients with acute low back pain

AU - Myers, Samuel S.

AU - Phillips, Russell S.

AU - Davis, Roger B.

AU - Cherkin, Daniel C.

AU - Legedza, Anna

AU - Kaptchuk, Ted J.

AU - Hrbek, Andrea

AU - Buring, Julie E.

AU - Post, Diana

AU - Connelly, Maureen T.

AU - Eisenberg, David M.

N1 - Funding Information: Funding/Support: The project described was supported by Grant Number 1 R01 AT 00144 from the National Center for Complementary and Alternative Medicine. This work has also been supported in part by a generous endowment from the Bernard Osher Foundation and an unrestricted educational grant from American Specialty Health. Dr. Myers was supported by an Institutional National Research Service Award (T32AT00051-06) from the National Institutes of Health when this research was performed. Dr. Phillips is supported by a Mid-Career Investigator Award from the National Center for Complementary and Alternative Medicine, National Institutes of Health (K24-AT000589). The funding organizations did not provide any input into the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review or approval of the manuscript.

PY - 2008/2

Y1 - 2008/2

N2 - 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.

AB - 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.

KW - Choice

KW - Expectations

KW - Low back pain

KW - Preference

KW - Randomized controlled trial

UR - http://www.scopus.com/inward/record.url?scp=39149111950&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=39149111950&partnerID=8YFLogxK

U2 - 10.1007/s11606-007-0460-5

DO - 10.1007/s11606-007-0460-5

M3 - Article

C2 - 18066631

AN - SCOPUS:39149111950

SN - 0884-8734

VL - 23

SP - 148

EP - 153

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

IS - 2

ER -

Patient expectations as predictors of outcome in patients with acute low back pain

Abstract

Bibliographical note

Keywords

Publisher link

Find It

Other files and links

Fingerprint

Cite this