title: The role of patients' expectation of appropriate initial manual therapy treatment in outcomes for patients with low back pain.
abstract: OBJECTIVE
  The purpose of this study was to compare the outcomes of patients with low back pain who had a matched, unmatched, or were indifferent with their pretreatment expectation/preference to the manual therapy thrust or nonthrust intervention. A secondary purpose was to explore baseline patient characteristics affiliated with a preference of manual therapy treatment type (thrust or nonthrust manipulation).
  
  
  METHODS
  The study is a secondary analysis of a prospective randomized controlled trial that enrolled 149 patients with low back pain, from 16 distinct outpatient physical therapy practices within the United States. Patient's pretreatment expectations were identified before randomization. The intervention included manual therapy (thrust or nonthrust manipulation) with a standardized exercise program, which was carried out for 2 treatment sessions. Six outcomes captured the constructs of (a) disability, (b) pain perception, (c) care intensity, (d) fear avoidance behaviors, and (e) perception of extent of recovery. Descriptive statistics, analysis of variance (and Tukey, a post hoc test), Fisher exact test, and a multivariate logistic regression analysis were used for analysis.
  
  
  RESULTS
  There were no statistical differences in any of the 6 dedicated outcomes measures between the matched, unmatched, and no preference groups. Therapist-determined patient "irritability" was associated with patient preference of nonthrust treatment, and higher body mass index was associated with patient preference of thrust treatment.
  
  
  CONCLUSIONS
  This study shows that patients demonstrated no statistical difference in disability or pain outcome measures when matched, unmatched, or indifferent to the intervention.
authors.affiliation: Walsh University, North Canton, Ohio 44720, USA. mdonaldson@walsh.edu
authors.forename: Megan
authors.initials: M
authors.lastname: Donaldson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Learman
authors.forename: Bryan
authors.initials: B
authors.lastname: O'Halloran
authors.forename: Christopher
authors.initials: C
authors.lastname: Showalter
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D015444:Exercise; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D014481:United States
keywords: Low Back Pain; Musculoskeletal Manipulations; Patient Preference