Defining worthwhile and desired responses to treatment of chronic low back pain.
OBJECTIVE
To describe patients' perceptions of minimum worthwhile and desired reductions in pain and disability upon commencing treatment for chronic low back pain.


METHODS
Descriptive study nested within a community-based randomized controlled trial on prolotherapy injections and exercises.


METHODS
A total of 110 participants with chronic low back pain. Interventions. Prior to treatment, participants were asked what minimum percentage reductions in pain and disability would make treatment worthwhile and what percentage reductions in pain and disability they desired with treatment.


METHODS
Minimum worthwhile reductions and desired reductions in pain and disability.


RESULTS
Median (inter-quartile range) minimum worthwhile reductions were 25% (20%, 50%) for pain and 35% (20%, 50%) for disability. This compared with desired reductions of 80% (60%, 100%) for pain and 80% (50%, 100%) for disability. The internal consistency between pain and disability responses was high (Spearman's coefficient of association of 0.81 and 0.87, respectively). A significant association existed between minimum worthwhile reductions and desired reductions, but no association was found between these two factors and patient age, gender, pain severity or duration, disability, anxiety, depression, response to treatment, or treatment satisfaction.


CONCLUSIONS
Inquiring directly about patients' expectations of reductions in pain and in disability is important in establishing realistic treatment goals and setting benchmarks for success. There is a wide disparity between the reductions that they regard as minimum worthwhile and reductions that they hope to achieve. However, there is a high internal consistency between reductions in pain and disability that they expect.
Yelland
Michael J
MJ
School of Medicine, Griffith University and Faculty of Health and Environmental Sciences, Auckland University of Technology, Australia.
Schluter
Philip J
PJ
D000328:Adult; D000367:Age Factors; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D015331:Cohort Studies; D003863:Depression / Q000209:etiology / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D005947:Glucose / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008012:Lidocaine / Q000494:pharmacology / Q000627:therapeutic use; D008022:Ligaments / Q000187:drug effects / Q000503:physiopathology; D017116:Low Back Pain / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017288:Pain Threshold / Q000523:psychology; D010148:Intractable Pain / Q000523:psychology* / Q000628:therapy*; D010353:Patient Education as Topic; D010817:Physician-Patient Relations
D008012:Lidocaine; D005947:Glucose