Original Article

Journal of General Internal Medicine

, Volume 23, Issue 2, pp 148-153

Patient Expectations as Predictors of Outcome In Patients with Acute Low Back Pain

  • Samuel S. MyersAffiliated withDepartment of Medicine, Harvard Medical School, Mount Auburn Hospital Email author 
  • , Russell S. PhillipsAffiliated withDivision for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical SchoolDivision of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center
  • , Roger B. DavisAffiliated withDivision for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical SchoolDivision of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center
  • , Daniel C. CherkinAffiliated withGroup Health Center for Health Studies
  • , Anna LegedzaAffiliated withDivision for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical SchoolDivision of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center
  • , Ted J. KaptchukAffiliated withDivision for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School
  • , Andrea HrbekAffiliated withDivision for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School
  • , Julie E. BuringAffiliated withDivision for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School
  • , Diana PostAffiliated withDivision for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School
    • , Maureen T. ConnellyAffiliated withDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care
    • , David M. EisenbergAffiliated withDivision for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical SchoolDivision of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center

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Abstract

BACKGROUND

Few studies have evaluated the association between patient expectations for recovery and clinical outcomes, and no study has evaluated whether asking patients to choose their therapy modifies such an association.

OBJECTIVE

To evaluate the association between patients’ expectations and functional recovery in patients with acute low back pain (LBP), and to determine whether that association is affected by giving patients choice of therapy.

DESIGN AND PARTICIPANTS

A secondary analysis of a randomized controlled trial comparing usual care alone to usual care plus choice of chiropractic, acupuncture, or massage in 444 adults with acute LBP, lasting less than 21 days.

MEASUREMENTS AND MAIN RESULTS

Primary outcome was functional disability (Roland score) at 5 and 12 weeks. Patients’ general expectations for improvement were associated with improvement in functional status (β = 0.96, 95% CI = 0.56, 1.36). A 1-point increase in general expectations was associated with a 0.96-point improvement in Roland score. The association of expectation with outcome was 2–3 times greater in the usual care group than the choice group. However, these differences did not reach statistical significance.

CONCLUSIONS

In patients with acute LBP, higher expectations for recovery are associated with greater functional improvement. Eliciting patient expectations for improvement may be a simple way to identify patients with the highest (or lowest) likelihood of experiencing functional improvement. Incorporating questions about patient expectations in future trials may clarify the role of this important correlate of clinical outcomes.

KEY WORDS

expectations preference choice low back pain randomized controlled trial