title: Can Patients With Low Back Pain Be Satisfied With Less Than Expected?
abstract: METHODS
  A prospective cohort study within care as usual.
  
  
  OBJECTIVE
  (1) To explore the psychometric properties of a baseline disability questionnaire designed to collect patients' expectation. (2) To analyze relations between satisfaction with care and treatment success in patients with chronic low back pain (CLBP). (3) To determine the chances of being satisfied with the received care in absence of treatment success.
  
  
  BACKGROUND
  There is a lack of evidence on determinants of treatment satisfaction in patients with CLBP, specifically the role of patient's expectation of disability reduction after treatment.
  
  
  METHODS
  Treatment expectation was measured with questions inspired by the Pain Disability Index (PDI) at baseline. Treatment success was considered if disability at the end of therapy was lower than, or equal to pretreatment expectation. An exploratory factor analysis was performed on the new questionnaire. Binary logistic regression models were used to analyze how much variance of satisfaction with care was explained by treatment success, pain disability at baseline, sex, age, duration of complaints, and pain intensity. The odds ratio of being satisfied when treatment was successful was calculated.
  
  
  RESULTS
  Six hundred nine patients were included. The factor structure of the PDI-expectancy had optimal fit with a one factor structure. There were low correlations between the expected and baseline disability, pain intensity, and duration of pain. Correlation between treatment success and satisfaction with care was low (χ = 0.13; P < 0.01). Treatment success had a low contribution to satisfaction with care. Of all participating patients, 51.4% were satisfied with care even when treatment was not successful. The odds ratio for being satisfied was 2.42 when treatment was successful compared to when treatment was not successful.
  
  
  CONCLUSIONS
  The PDI-expectancy is internally consistent. Pretreatment expectation contributes uniquely but slightly to satisfaction with care; patients whose treatment was considered successful have 1.38 to 4.24 times higher chance of being satisfied at the end of treatment. Even when treatment was not successful, 51.4% of the patients with CLBP are satisfied with care.
  
  
  METHODS
  2.
authors.affiliation: Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Hanze University of Applied Sciences, Groningen, The Netherlands.
authors.forename: Wouter L
authors.initials: WL
authors.lastname: Silvis
authors.affiliation: Hanze University of Applied Sciences, Groningen, The Netherlands.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Lakke
authors.affiliation: Groningen Spine Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Stegeman
authors.affiliation: Groningen Spine Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Bert L G N
authors.initials: BLGN
authors.lastname: Speijer
authors.affiliation: Groningen Spine Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Patrick C A J
authors.initials: PCAJ
authors.lastname: Vroomen
authors.affiliation: Groningen Spine Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Maarten H
authors.initials: MH
authors.lastname: Coppes
authors.affiliation: Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Groningen Spine Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Michiel F
authors.initials: MF
authors.lastname: Reneman
authors.affiliation: Groningen Spine Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Expertise Center of Health and Wellbeing, Saxion University of Applied Sciences, Enschede, The Netherlands.
authors.forename: Remko
authors.initials: R
authors.lastname: Soer
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011594:Psychometrics; D017211:Treatment Failure