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

Andreas Eklund*, Diana De Carvalho, Isabelle Pagé, Arnold Y L Wong, Melker S Johansson, Katherine A Pohlman, Jan Hartvigsen, Michael Swain

*Corresponding author for this work

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Abstract

BACKGROUND: Low back pain (LBP) is a global public health challenge, which causes high healthcare costs and the highest burden on society in terms of years lived with disability. While patients' 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 (a) patients' expectations predicted short-term outcome, and (b) 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. Patients' 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 patients' expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patients' expectations at the first visit to best inform prognosis.

SIGNIFICANCE: This study confirms the importance of patients' expectations in a clinical setting. Patients' expectations predict the short-term outcome of chiropractic care for LBP. Pain intensity, psychological profile and self-rated health did not modify this relationship.

Original languageEnglish
JournalEuropean Journal of Pain
Volume23
Issue number7
Pages (from-to)1378-1389
ISSN1090-3801
DOIs
Publication statusPublished - Aug 2019

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Low Back Pain
Randomized Controlled Trials
Chiropractic
Health
Public Health

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Eklund, Andreas ; De Carvalho, Diana ; Pagé, Isabelle ; Wong, Arnold Y L ; Johansson, Melker S ; Pohlman, Katherine A ; Hartvigsen, Jan ; Swain, Michael. / Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial. In: European Journal of Pain. 2019 ; Vol. 23, No. 7. pp. 1378-1389.
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title = "Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial",
abstract = "BACKGROUND: Low back pain (LBP) is a global public health challenge, which causes high healthcare costs and the highest burden on society in terms of years lived with disability. While patients' 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 (a) patients' expectations predicted short-term outcome, and (b) 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. Patients' 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 patients' expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patients' expectations at the first visit to best inform prognosis.SIGNIFICANCE: This study confirms the importance of patients' expectations in a clinical setting. Patients' expectations predict the short-term outcome of chiropractic care for LBP. Pain intensity, psychological profile and self-rated health did not modify this relationship.",
author = "Andreas Eklund and {De Carvalho}, Diana and Isabelle Pag{\'e} and Wong, {Arnold Y L} and Johansson, {Melker S} and Pohlman, {Katherine A} and Jan Hartvigsen and Michael Swain",
year = "2019",
month = "8",
doi = "10.1002/ejp.1407",
language = "English",
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pages = "1378--1389",
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Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial. / Eklund, Andreas; De Carvalho, Diana; Pagé, Isabelle; Wong, Arnold Y L; Johansson, Melker S; Pohlman, Katherine A; Hartvigsen, Jan; Swain, Michael.

In: European Journal of Pain, Vol. 23, No. 7, 08.2019, p. 1378-1389.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial

AU - Eklund, Andreas

AU - De Carvalho, Diana

AU - Pagé, Isabelle

AU - Wong, Arnold Y L

AU - Johansson, Melker S

AU - Pohlman, Katherine A

AU - Hartvigsen, Jan

AU - Swain, Michael

PY - 2019/8

Y1 - 2019/8

N2 - BACKGROUND: Low back pain (LBP) is a global public health challenge, which causes high healthcare costs and the highest burden on society in terms of years lived with disability. While patients' 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 (a) patients' expectations predicted short-term outcome, and (b) 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. Patients' 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 patients' expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patients' expectations at the first visit to best inform prognosis.SIGNIFICANCE: This study confirms the importance of patients' expectations in a clinical setting. Patients' expectations predict the short-term outcome of chiropractic care for LBP. Pain intensity, psychological profile and self-rated health did not modify this relationship.

AB - BACKGROUND: Low back pain (LBP) is a global public health challenge, which causes high healthcare costs and the highest burden on society in terms of years lived with disability. While patients' 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 (a) patients' expectations predicted short-term outcome, and (b) 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. Patients' 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 patients' expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patients' expectations at the first visit to best inform prognosis.SIGNIFICANCE: This study confirms the importance of patients' expectations in a clinical setting. Patients' expectations predict the short-term outcome of chiropractic care for LBP. Pain intensity, psychological profile and self-rated health did not modify this relationship.

U2 - 10.1002/ejp.1407

DO - 10.1002/ejp.1407

M3 - Journal article

VL - 23

SP - 1378

EP - 1389

JO - European Journal of Pain

JF - European Journal of Pain

SN - 1090-3801

IS - 7

ER -