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


METHODS
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.


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 (beta = 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.
Myers
Samuel S
SS
Department of Medicine, Harvard Medical School, Mount Auburn Hospital, Cambridge, MA 02138, USA. Sam_Myers@hms.harvard.edu
Phillips
Russell S
RS
Davis
Roger B
RB
Cherkin
Daniel C
DC
Legedza
Anna
A
Kaptchuk
Ted J
TJ
Hrbek
Andrea
A
Buring
Julie E
JE
Post
Diana
D
Connelly
Maureen T
MT
Eisenberg
David M
DM
D000208:Acute Disease; D000328:Adult; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000534:rehabilitation* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D016896:Treatment Outcome