title: Preference, expectation, and satisfaction in a clinical trial of behavioral interventions for acute and sub-acute low back pain.
abstract: The equivalency of behavioral interventions has led to the consideration of whether patient-related factors influence clinical trial outcomes. The primary purpose of this secondary analysis was to determine if treatment preference and patient expectation were predictors of trial outcomes and if selected patient-satisfaction items were appropriate as outcome measures. Perceived effectiveness, treatment preference, and patient expectation were assessed before random assignment, and patient satisfaction was assessed 6 months later. Patient preference was associated with perceived effectiveness for those with no treatment preference and those preferring graded exposure. Higher patient expectation was associated with higher perceived effectiveness ratings for all treatments in the clinical trial. Patients with no strong treatment preferences had larger 6-month improvements in pain intensity and disability, while patients with higher expectations had lower disability at baseline, 4 weeks, and 6 months. Patient satisfaction rates did not differ based on treatment received. Patient satisfaction was highest with treatment delivery and much lower with treatment effect. Patient satisfaction was uniformly associated with expectations being met, but only satisfaction with treatment effect was associated with lower pain and disability scores. These data support assessment of treatment preference and patient expectation as predictors and patient satisfaction as an outcome measure in low back pain (LBP) clinical trials.
  
  
  CONCLUSIONS
  These data indicate treatment preference potentially impacts rate of improvement for patients with low back pain. Patient expectation did not impact rate of improvement, but those with higher expectations had lower pain and disability scores throughout the trial. Optimal assessment of patient satisfaction should include items that separately consider treatment delivery and effect.
authors.affiliation: Department of Physical Therapy, Center for Pain Research and Behavioral Health, PO Box 100154, University of Florida, Gainesville, Florida 32611-0154, USA. szgeorge@phhp.ufl.edu
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
authors.forename: Michael E
authors.initials: ME
authors.lastname: Robinson
mesh_terms: D000208:Acute Disease; D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D057240:Patient Preference / Q000523:psychology*; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D055815:Young Adult
references.citation: Spine (Phila Pa 1976). 1996 Mar 15;21(6):741-9
references.pmid: 8882698
references.citation: Clin J Pain. 2005 Mar-Apr;21(2):109-19
references.pmid: 15722803
references.citation: Pain. 2007 Apr;128(3):264-271
references.pmid: 17257756
references.citation: Clin J Pain. 2005 Jul-Aug;21(4):302-10
references.pmid: 15951647
references.citation: J Pain Symptom Manage. 1997 Nov;14(5):292-9
references.pmid: 9392923
references.citation: Ann Intern Med. 2007 Oct 2;147(7):478-91
references.pmid: 17909209
references.citation: BMC Musculoskelet Disord. 2006 Jan 20;7:5
references.pmid: 16426449
references.citation: Arch Phys Med Rehabil. 2005 Jul;86(7):1338-44
references.pmid: 16003661
references.citation: Spine (Phila Pa 1976). 1998 Dec 1;23(23):2625-30
references.pmid: 9854762
references.citation: Pain. 2008 Nov 15;140(1):145-157
references.pmid: 18786762
references.citation: Eur J Pain. 2008 Oct;12(7):879-85
references.pmid: 18226936
references.citation: Ann Intern Med. 2004 Jan 20;140(2):77-84
references.pmid: 14734329
references.citation: Pain. 2005 Jun;115(3):338-347
references.pmid: 15911161
references.citation: J Gen Intern Med. 1999 Dec;14(12):740-4
references.pmid: 10632818
references.citation: Pain. 1999 Nov;83(2):157-62
references.pmid: 10534586
references.citation: Spine (Phila Pa 1976). 1987 Sep;12(7 Suppl):S1-59
references.pmid: 2961086
references.citation: CMAJ. 2002 Mar 19;166(6):749-54
references.pmid: 11944761
references.citation: Spine (Phila Pa 1976). 2007 Jan 15;32(2):151-8
references.pmid: 17224808
references.citation: Phys Ther. 2000 Sep;80(9):853-63
references.pmid: 10960933
references.citation: Lancet. 2005 Jun 11-17;365(9476):2024-30
references.pmid: 15950716
references.citation: Patient Educ Couns. 1998 Jun;34(2):169-78
references.pmid: 9731176
references.citation: J Pain Symptom Manage. 2002 Mar;23(3):211-20
references.pmid: 11888719
references.citation: J Occup Environ Med. 2006 Nov;48(11):1173-80
references.pmid: 17099454
references.citation: Spine (Phila Pa 1976). 1995 Feb 15;20(4):473-7
references.pmid: 7747232
references.citation: BMJ. 1999 Jul 31;319(7205):279-83
references.pmid: 10426734
references.citation: BMJ. 1998 Jan 31;316(7128):360
references.pmid: 9487173
references.citation: J Health Serv Res Policy. 1996 Oct;1(4):194-7
references.pmid: 10180870
references.citation: J Pain. 2008 Feb;9(2):105-21
references.pmid: 18055266
references.citation: Spine (Phila Pa 1976). 2000 Aug 1;25(15):1973-6
references.pmid: 10908942
references.citation: Phys Ther. 2002 Jun;82(6):557-65
references.pmid: 12036397
references.citation: Phys Ther. 1992 Apr;72(4):279-90; discussion 291-3
references.pmid: 1533941
references.citation: Pain Med. 2005 Sep-Oct;6(5):336-45
references.pmid: 16266354
references.citation: Spine J. 2002 Nov-Dec;2(6):391-9; discussion 399-401
references.pmid: 14589256
references.citation: Cochrane Database Syst Rev. 2005 Jan 25;(1):CD002014
references.pmid: 15674889
references.citation: Pain. 1996 Sep;67(1):35-40
references.pmid: 8895229
references.citation: Spine (Phila Pa 1976). 1998 Sep 15;23(18):2003-13
references.pmid: 9779535
references.citation: Spine (Phila Pa 1976). 2003 Dec 1;28(23):2551-60
references.pmid: 14652471
references.citation: Spine (Phila Pa 1976). 2003 Aug 15;28(16):1757-65
references.pmid: 15662744
references.citation: Spine (Phila Pa 1976). 2008 Nov 15;33(24):2663-8
references.pmid: 18981962
references.citation: Spine (Phila Pa 1976). 2001 Jul 1;26(13):1418-24
references.pmid: 11458142
references.citation: J Pain Symptom Manage. 1996 Apr;11(4):242-51
references.pmid: 8869459
references.citation: J Gen Intern Med. 2008 Feb;23(2):148-53
references.pmid: 18066631
references.citation: J Health Serv Res Policy. 1996 Apr;1(2):77-80
references.pmid: 10180853
references.citation: Spine (Phila Pa 1976). 2003 Oct 15;28(20):2309-15; discussion 2316
references.pmid: 14560075