title: A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies.
abstract: BACKGROUND
  The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy.
  
  
  METHODS
  We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time.
  
  
  RESULTS
  Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a "positive outcome". Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health.
  
  
  CONCLUSIONS
  The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.
authors: Department of Family and Community Medicine & School of Anthropology, University of Arizona, Tucson, AZ, USA. emerye@email.arizona.edu.
authors: Emery R
authors: ER
authors: Eaves
authors: Group Health Research Institute, Seattle, USA. sherman.k@ghc.org.
authors: Karen J
authors: KJ
authors: Sherman
authors: Department of Family and Community Medicine & School of Anthropology, University of Arizona, Tucson, AZ, USA. ritenbau@email.arizona.edu.
authors: Cheryl
authors: C
authors: Ritenbaugh
authors: Group Health Research Institute, Seattle, USA. hsu.c@ghc.org.
authors: Clarissa
authors: C
authors: Hsu
authors: Department of Family and Community Medicine & School of Anthropology, University of Arizona, Tucson, AZ, USA. mnichter@email.arizona.edu.
authors: Mark
authors: M
authors: Nichter
authors: Department of Psychiatry & Behavioral Sciences and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA. jturner@u.washington.edu.
authors: Judith A
authors: JA
authors: Turner
authors: Group Health Research Institute, Seattle, USA. cherkin.d@ghc.org.
authors: Daniel C
authors: DC
authors: Cherkin
mesh_terms: D015670:Acupuncture Therapy; D000328:Adult; D001364:Awareness; D059350:Chronic Pain; D000529:Complementary Therapies / Q000379:methods* / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy*; D008297:Male; D026882:Manipulation, Chiropractic; D008405:Massage; D019122:Meditation; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D010146:Pain; D059408:Pain Management; D036301:Qualitative Research; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015013:Yoga
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