title: Link Between Positive Clinician-Conveyed Expectations of Treatment Effect and Pain Reduction in Knee Osteoarthritis, Mediated by Patient Self-Efficacy.
abstract: A prior knee osteoarthritis (OA) trial found that provider-conveyed expectations for treatment success were associated with pain improvement. We hypothesized this relationship was mediated by patient self-efficacy, since expectations of improvement may enhance one's ability to control health behaviors, and therefore health. Our aim was to examine whether self-efficacy was a mediator of the relationship observed in this trial.
  
  
  
  A secondary analysis of a 3-arm (traditional acupuncture, sham acupuncture, and wait list) trial for knee OA was conducted. Those in the acupuncture groups were equally randomized to acupuncturists trained to communicate a high or neutral expectation of treatment success (e.g., using language conveying high or unclear likelihood that acupuncture would reduce knee pain). A modified Arthritis Self-Efficacy Questionnaire and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale were administered. Linear regression analyses were used to examine whether patient self-efficacy mediated the relationship between provider communication style and knee pain at 3 months.
  
  
  
  High-expectation provider communication was associated with patient self-efficacy, β coefficient of 0.14 (95% confidence interval [95% CI] 0.01, 0.28). Self-efficacy was associated with WOMAC pain, β coefficient of -9.29 (95% CI -11.11, -7.47), while controlling for the provider communication style. The indirect effect a × b of -1.36 for high versus neutral expectation (bootstrap 95% CI -2.80, -0.15; does not include 0), supports the conclusion that patient self-efficacy mediates the relationship between provider-communicated expectations of treatment effects and knee pain.
  
  
  
  Our findings suggest that clinician-conveyed expectations can enhance the benefit of treatments targeting knee OA symptoms, mediated by improved patient self-efficacy.
authors.affiliation: Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Grace
authors.initials: G
authors.lastname: Hsiao-Wei Lo
authors.affiliation: Texas A&M University Health Science Center, College Station.
authors.forename: Ajay S
authors.initials: AS
authors.lastname: Balasubramanyam
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Andrea
authors.initials: A
authors.lastname: Barbo
authors.affiliation: Texas A&M University, College Station, and Baylor College of Medicine, Houston.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D015670:Acupuncture Therapy; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000523:psychology* / Q000628:therapy; D010146:Pain / Q000209:etiology / Q000523:psychology*; D059408:Pain Management / Q000379:methods / Q000523:psychology*; D011369:Professional-Patient Relations; D020377:Self Efficacy