European Spine Journal

, Volume 22, Issue 9, pp 1986–1995

How do low back pain patients conceptualize their expectations regarding treatment? Content analysis of interviews

  • T. M. Haanstra
  • L. Hanson
  • R. Evans
  • F. A. van Nes
  • H. C. W. De Vet
  • P. Cuijpers
  • R. W. J. G. Ostelo
Original Article

Abstract

Purpose

The purpose of this study was to gain insight into how low back pain (LBP) patients conceptualize the construct of expectations regarding treatment.

Methods

This study was nested within a mixed-method randomized clinical trial comparing three primary care interventions for LBP. A total of 77 participants with LBP lasting longer than 6 weeks were included; semi-structured interviews were conducted querying patients about their expectations for treatment. Also factors influencing their expectations were explored. Interviews were administered following enrollment into the study, but prior to study treatment. Two researchers independently conducted a content analysis using NVIVO 9 software.

Results

LBP patients’ expectations could be categorized in two main domains: outcome and process expectations, each with subdomains. Patients expressed expectations in all subdomains both as values (what they hoped) and probabilities (what they thought was likely). In multiple subdomains, there were differences in the nature (positive vs. negative) and frequency of value and probability expectations. Participants reported that multiple factors influenced their expectations of which past experience with treatment appeared to be of major influence on probability expectations.

Conclusion and recommendations

This study showed that LBP patients’ expectations for treatment are multifaceted. Current measurement instruments do not cover all domains and subdomains of expectations. Therefore, we recommend the development of new or improved measures that make a distinction between value and probability expectations and assess process and/or outcome expectations covering multiple subdomains. Some of the influencing factors found in this study may be useful targets for altering patients’ treatment expectations and improving health outcomes.

Keywords

Patients’ expectations Low back pain Qualitative research Psychological factors Patient preference 

References

  1. 1.
    Hoy D, Brooks P, Blyth F, Buchbinder R (2010) The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 24:769–781PubMedCrossRefGoogle Scholar
  2. 2.
    Andersson GB (1999) Epidemiological features of chronic low-back pain. Lancet 354:581–585PubMedCrossRefGoogle Scholar
  3. 3.
    Hoy D, March L, Brooks P, Woolf A, Blyth F, Vos T, Buchbinder R (2010) Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol 24:155–165PubMedCrossRefGoogle Scholar
  4. 4.
    Bialosky JE, Bishop MD, Cleland JA (2010) Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain. Phys Ther 90:1345–1355PubMedCrossRefGoogle Scholar
  5. 5.
    Bishop MD, Bialosky JE, Cleland JA (2011) Patient expectations of benefit from common interventions for low back pain and effects on outcome: secondary analysis of a clinical trial of manual therapy interventions. J Man Manip Ther 19:20–25PubMedCrossRefGoogle Scholar
  6. 6.
    Foster NE, Delitto A (2011) Embedding psychosocial perspectives within clinical management of low back pain: integration of psychosocially informed management principles into physical therapist practice–challenges and opportunities. Phys Ther 91:790–803PubMedCrossRefGoogle Scholar
  7. 7.
    Iles RA, Davidson M, Taylor NF, O’Halloran P (2009) Systematic review of the ability of recovery expectations to predict outcomes in non-chronic non-specific low back pain. J Occup Rehabil 19:25–40PubMedCrossRefGoogle Scholar
  8. 8.
    Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G (2006) European guidelines for the management of chronic nonspecific low back pain. Chap 4. Eur Spine J 15(Suppl 2):S192–S300PubMedCrossRefGoogle Scholar
  9. 9.
    van Hartingsveld F, Ostelo RWJG, Cuijpers P, de Vos R, Riphagen II, de Vet HCW (2010) Treatment-related and patient-related expectations of patients with musculoskeletal disorders: a systematic review of published measurement tools. Clin J Pain 26:470–488PubMedCrossRefGoogle Scholar
  10. 10.
    Leung KK, Silvius JL, Pimlott N, Dalziel W, Drummond N (2009) Why health expectations and hopes are different: the development of a conceptual model. Health Expect 12:347–360PubMedCrossRefGoogle Scholar
  11. 11.
    Janzen JA, Silvius J, Jacobs S, Slaughter S, Dalziel W, Drummond N (2006) What is a health expectation? Developing a pragmatic conceptual model from psychological theory. Health Expect 9:37–48PubMedCrossRefGoogle Scholar
  12. 12.
    Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:191–215PubMedCrossRefGoogle Scholar
  13. 13.
    Bandura A (1982) The assessment and predictive generality of self-percepts of efficacy. J Behav Ther Exp Psychiatry 13:195–199PubMedCrossRefGoogle Scholar
  14. 14.
    Crow R, Gage H, Hampson S, Hart J, Kimber A, Thomas H (1999) The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review. Health Technol Assess 3:1–96PubMedGoogle Scholar
  15. 15.
    Thompson AG, Sunol R (1995) Expectations as determinants of patient satisfaction: concepts, theory and evidence. Int J Qual Health Care 7:127–141PubMedGoogle Scholar
  16. 16.
    Kravitz RL (1996) Patients’ expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev 53:3–27PubMedCrossRefGoogle Scholar
  17. 17.
    Stewart-Williams S (2004) The placebo puzzle: putting together the pieces. Health Psychol 23:198–206PubMedCrossRefGoogle Scholar
  18. 18.
    Iles RA, Taylor NF, Davidson M, O’Halloran PD (2012) Patient recovery expectations in non-chronic non-specific low back pain: a qualitative investigation. J Rehabil Med 44:781–787PubMedCrossRefGoogle Scholar
  19. 19.
    Shaw WS, Huang YH (2005) Concerns and expectations about returning to work with low back pain: identifying themes from focus groups and semi-structured interviews. Disabil Rehabil 27:1269–1281PubMedCrossRefGoogle Scholar
  20. 20.
    Stewart AM, Polak E, Young R, Schultz IZ (2012) Injured workers’ construction of expectations of return to work with sub-acute back pain: the role of perceived uncertainty. J Occup Rehabil 22:1–14PubMedCrossRefGoogle Scholar
  21. 21.
    Bronfort G, Maiers MJ, Evans RL, Schulz CA, Bracha Y, Svendsen KH, Grimm RH Jr, Owens EF Jr, Garvey TA, Transfeldt EE (2011) Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. Spine J 11:585–598PubMedCrossRefGoogle Scholar
  22. 22.
    Creswell JW, Plano Clarck VL (2012) Designing and conducting mixed methods research, vol 2. SAGE publications, Los AngelesGoogle Scholar
  23. 23.
    Evans RL, Maiers MJ, Bronfort G (2003) What do patients think? Results of a mixed methods pilot study assessing sciatica patients’ interpretations of satisfaction and improvement. J Manipulative Physiol Ther 26:502–509PubMedCrossRefGoogle Scholar
  24. 24.
    David D, Montgomery GH, Stan R, Dilorenzo T, Erblich J (2004) Discrimination between hopes and expectancies for nonvolitional outcomes: psychological phenomenon or artifact? Pers Individ Dif 36:1945–1952PubMedCrossRefGoogle Scholar
  25. 25.
    Montgomery GH, David D, Dilorenzo T, Erblich J (2003) Is hoping the same as expecting? Discrimination between hopes and response expectancies for nonvolitional outcomes. Pers Individ Dif 35:399–409PubMedCrossRefGoogle Scholar
  26. 26.
    Main CJ, Foster N, Buchbinder R (2010) How important are back pain beliefs and expectations for satisfactory recovery from back pain? Best Pract Res Clin Rheumatol 24:205–217PubMedCrossRefGoogle Scholar
  27. 27.
    Elwyn G, Edwards A, Kinnersley P (1999) Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract 49:477–482PubMedGoogle Scholar
  28. 28.
    Coulter A (2012) Patient engagement–what works? J Ambul Care Manage 35:80–89PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • T. M. Haanstra
    • 1
  • L. Hanson
    • 2
  • R. Evans
    • 2
  • F. A. van Nes
    • 3
    • 6
  • H. C. W. De Vet
    • 1
  • P. Cuijpers
    • 4
  • R. W. J. G. Ostelo
    • 1
    • 5
  1. 1.Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care ResearchVU University Medical CentreAmsterdamThe Netherlands
  2. 2.Wolfe Harris Center for Clinical StudiesNorthwestern Health Sciences UniversityBloomingtonUSA
  3. 3.Longitudinal Aging Study Amsterdam, EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
  4. 4.Department of Clinical Psychology and the EMGO Institute for Health and Care ResearchVU UniversityAmsterdamThe Netherlands
  5. 5.Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life SciencesVU UniversityAmsterdamThe Netherlands
  6. 6.Amsterdam School of Health Professions, Occupational TherapyAmsterdamThe Netherlands

Personalised recommendations