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



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


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.


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.


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


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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

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