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Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial [Epub ahead of print]

Tidsskriftartikel - 2019

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BACKGROUND: Low back pain (LBP) is a global public health challenge, which causes high health-care costs and the highest burden on society in terms of years lived with disability. While patient expectations for improvement may have effects on LBP treatment outcomes, it remains unclear if psychological profiles modify this relationship. Therefore, the objectives of this study were to investigate if (1) patient expectations predicted short-term outcome, and (2) psychological profile, pain intensity, and self-rated health modified the relationship between expectations and outcome.

METHODS: Data were collected between April 2012 and January 2016 during the inclusion into a randomized controlled trial. Potentially eligible participants were identified through 40 chiropractic clinics located across Sweden. Patient expectations, psychological profile, pain intensity, activity limitation, and self-rated health were collected from patients with recurrent persistent LBP during their first chiropractic visit (n=593). Subjective improvement was measured at the fourth visit.

RESULTS: Patients with a high expectation of improvement had 58% higher risk to report an improvement at the fourth visit (RR=1.58, 95% CI: 1.28, 1.95). Controlling for potential confounders only slightly decreased the strength of this association (RR=1.49, 95% CI: 1.20, 1.86). Baseline pain intensity, psychological profile, and self-rated health did not modify the effect of expectation on outcome.

CONCLUSIONS: Baseline patient expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patient expectations at the first visit to best inform prognosis. This article is protected by copyright. All rights reserved.

Reference

Eklund A, De Carvalho D, Pagé I, Wong A, Johansson M, Pohlman K, Hartvigsen J, Swain M. Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial [Epub ahead of print]. European Journal of Pain 2019.
doi: 10.1002/ejp.1407

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