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

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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.

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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.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, Harvard Medical School, Mount Auburn Hospital, Cambridge, MA, USA

    Samuel S. Myers MD

  2. Division for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School, Boston, MA, USA

    Russell S. Phillips MD, Roger B. Davis ScD, Anna Legedza ScD, Ted J. Kaptchuk, Andrea Hrbek, Julie E. Buring ScD, Diana Post MD & David M. Eisenberg MD

  3. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Russell S. Phillips MD, Roger B. Davis ScD, Anna Legedza ScD & David M. Eisenberg MD

  4. Group Health Center for Health Studies, Seattle, WA, USA

    Daniel C. Cherkin PhD

  5. Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA

    Maureen T. Connelly MD, MPH

Authors
  1. Samuel S. Myers MD
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  2. Russell S. Phillips MD
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  3. Roger B. Davis ScD
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  4. Daniel C. Cherkin PhD
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  5. Anna Legedza ScD
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  6. Ted J. Kaptchuk
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  7. Andrea Hrbek
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  8. Julie E. Buring ScD
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  9. Diana Post MD
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  10. Maureen T. Connelly MD, MPH
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  11. David M. Eisenberg MD
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Corresponding author

Correspondence to Samuel S. Myers MD.

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Myers, S.S., Phillips, R.S., Davis, R.B. et al. Patient Expectations as Predictors of Outcome In Patients with Acute Low Back Pain. J GEN INTERN MED 23, 148–153 (2008). https://doi.org/10.1007/s11606-007-0460-5

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  • DOI: https://doi.org/10.1007/s11606-007-0460-5

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