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

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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.

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Acknowledgments

T.M.H. was supported by a travel grant from the EMGO institute for Health and Care Research.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van den Boechorststraat 7, Room A-505, 1081 BT, Amsterdam, The Netherlands

    T. M. Haanstra, H. C. W. De Vet & R. W. J. G. Ostelo

  2. Wolfe Harris Center for Clinical Studies, Northwestern Health Sciences University, Bloomington, Minnesota, USA

    L. Hanson & R. Evans

  3. Longitudinal Aging Study Amsterdam, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

    F. A. van Nes

  4. Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands

    P. Cuijpers

  5. Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands

    R. W. J. G. Ostelo

  6. Amsterdam School of Health Professions, Occupational Therapy, Amsterdam, The Netherlands

    F. A. van Nes

Authors
  1. T. M. Haanstra
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  2. L. Hanson
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  3. R. Evans
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  4. F. A. van Nes
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  5. H. C. W. De Vet
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  6. P. Cuijpers
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  7. R. W. J. G. Ostelo
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Corresponding author

Correspondence to T. M. Haanstra.

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Haanstra, T.M., Hanson, L., Evans, R. et al. How do low back pain patients conceptualize their expectations regarding treatment? Content analysis of interviews. Eur Spine J 22, 1986–1995 (2013). https://doi.org/10.1007/s00586-013-2803-8

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  • DOI: https://doi.org/10.1007/s00586-013-2803-8

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