Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial.
Identifieur interne : 000582 ( Main/Exploration ); précédent : 000581; suivant : 000583Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial.
Auteurs : Andreas Eklund [Suède] ; Diana De Carvalho [Canada] ; Isabelle Pagé [Canada] ; Arnold Wong [République populaire de Chine] ; Melker S. Johansson [Danemark] ; Katherine A. Pohlman [États-Unis] ; Jan Hartvigsen [Danemark] ; Michael Swain [Australie]Source :
- European journal of pain (London, England) [ 1532-2149 ] ; 2019.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Coûts des soins de santé (MeSH), Essais contrôlés randomisés comme sujet (MeSH), Femelle (MeSH), Humains (MeSH), Lombalgie (psychologie), Lombalgie (thérapie), Manipulation de chiropraxie (MeSH), Mesure de la douleur (MeSH), Motivation (MeSH), Mâle (MeSH), Pronostic (MeSH), Résultat thérapeutique (MeSH).
- MESH :
English descriptors
- KwdEn :
- Adult (MeSH), Female (MeSH), Health Care Costs (MeSH), Humans (MeSH), Low Back Pain (psychology), Low Back Pain (therapy), Male (MeSH), Manipulation, Chiropractic (MeSH), Middle Aged (MeSH), Motivation (MeSH), Pain Measurement (MeSH), Prognosis (MeSH), Randomized Controlled Trials as Topic (MeSH), Treatment Outcome (MeSH).
- MESH :
- psychology : Low Back Pain.
- therapy : Low Back Pain.
- Adult, Female, Health Care Costs, Humans, Male, Manipulation, Chiropractic, Middle Aged, Motivation, Pain Measurement, Prognosis, Randomized Controlled Trials as Topic, Treatment Outcome.
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.
DOI: 10.1002/ejp.1407
PubMed: 31034102
PubMed Central: PMC6767754
Affiliations:
- Australie, Canada, Danemark, République populaire de Chine, Suède, États-Unis
- Hovedstaden, Nouvelle-Galles du Sud, Québec, Svealand, Texas
- Copenhague, Stockholm, Sydney, Trois-Rivières
- Université de Sydney, Université du Québec à Trois-Rivières
Links toward previous steps (curation, corpus...)
Le document en format XML
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A secondary analysis of data from a randomized clinical trial.</title><author><name sortKey="Eklund, Andreas" sort="Eklund, Andreas" uniqKey="Eklund A" first="Andreas" last="Eklund">Andreas Eklund</name><affiliation wicri:level="3"><nlm:affiliation>Unit of Intervention and Implementation Research for Worker Health, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.</nlm:affiliation><country xml:lang="fr">Suède</country><wicri:regionArea>Unit of Intervention and Implementation Research for Worker Health, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation></author><author><name sortKey="De Carvalho, Diana" sort="De Carvalho, Diana" uniqKey="De Carvalho D" first="Diana" last="De Carvalho">Diana De Carvalho</name><affiliation wicri:level="1"><nlm:affiliation>Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador</wicri:regionArea><wicri:noRegion>Newfoundland and Labrador</wicri:noRegion></affiliation></author><author><name sortKey="Page, Isabelle" sort="Page, Isabelle" uniqKey="Page I" first="Isabelle" last="Pagé">Isabelle Pagé</name><affiliation wicri:level="4"><nlm:affiliation>Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec</wicri:regionArea><orgName type="university">Université du Québec à Trois-Rivières</orgName><placeName><settlement type="city">Trois-Rivières</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Wong, Arnold" sort="Wong, Arnold" uniqKey="Wong A" first="Arnold" last="Wong">Arnold Wong</name><affiliation wicri:level="1"><nlm:affiliation>Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR</wicri:regionArea><wicri:noRegion>Hong Kong SAR</wicri:noRegion></affiliation></author><author><name sortKey="Johansson, Melker S" sort="Johansson, Melker S" uniqKey="Johansson M" first="Melker S" last="Johansson">Melker S. Johansson</name><affiliation wicri:level="1"><nlm:affiliation>Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:affiliation>National Research Centre for the Working Environment, Copenhagen, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>National Research Centre for the Working Environment, Copenhagen</wicri:regionArea><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation></author><author><name sortKey="Pohlman, Katherine A" sort="Pohlman, Katherine A" uniqKey="Pohlman K" first="Katherine A" last="Pohlman">Katherine A. Pohlman</name><affiliation wicri:level="2"><nlm:affiliation>Research Institute, Parker University, Dallas, Texas.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Research Institute, Parker University, Dallas</wicri:cityArea></affiliation></author><author><name sortKey="Hartvigsen, Jan" sort="Hartvigsen, Jan" uniqKey="Hartvigsen J" first="Jan" last="Hartvigsen">Jan Hartvigsen</name><affiliation wicri:level="1"><nlm:affiliation>Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Nordic Institute of Chiropractic and Clinical Biomechanics, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation></author><author><name sortKey="Swain, Michael" sort="Swain, Michael" uniqKey="Swain M" first="Michael" last="Swain">Michael Swain</name><affiliation wicri:level="3"><nlm:affiliation>Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney</wicri:regionArea><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation><affiliation wicri:level="4"><nlm:affiliation>Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Sydney, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Sydney</wicri:regionArea><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author></analytic><series><title level="j">European journal of pain (London, England)</title><idno type="eISSN">1532-2149</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Female (MeSH)</term><term>Health Care Costs (MeSH)</term><term>Humans (MeSH)</term><term>Low Back Pain (psychology)</term><term>Low Back Pain (therapy)</term><term>Male (MeSH)</term><term>Manipulation, Chiropractic (MeSH)</term><term>Middle Aged (MeSH)</term><term>Motivation (MeSH)</term><term>Pain Measurement (MeSH)</term><term>Prognosis (MeSH)</term><term>Randomized Controlled Trials as Topic (MeSH)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Coûts des soins de santé (MeSH)</term><term>Essais contrôlés randomisés comme sujet (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Lombalgie (psychologie)</term><term>Lombalgie (thérapie)</term><term>Manipulation de chiropraxie (MeSH)</term><term>Mesure de la douleur (MeSH)</term><term>Motivation (MeSH)</term><term>Mâle (MeSH)</term><term>Pronostic (MeSH)</term><term>Résultat thérapeutique (MeSH)</term></keywords><keywords scheme="MESH" qualifier="psychologie" xml:lang="fr"><term>Lombalgie</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Low Back Pain</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Low Back Pain</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Lombalgie</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Female</term><term>Health Care Costs</term><term>Humans</term><term>Male</term><term>Manipulation, Chiropractic</term><term>Middle Aged</term><term>Motivation</term><term>Pain Measurement</term><term>Prognosis</term><term>Randomized Controlled Trials as Topic</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Coûts des soins de santé</term><term>Essais contrôlés randomisés comme sujet</term><term>Femelle</term><term>Humains</term><term>Manipulation de chiropraxie</term><term>Mesure de la douleur</term><term>Motivation</term><term>Mâle</term><term>Pronostic</term><term>Résultat thérapeutique</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>SIGNIFICANCE</b></p><p>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.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">31034102</PMID><DateCompleted><Year>2020</Year><Month>06</Month><Day>15</Day></DateCompleted><DateRevised><Year>2021</Year><Month>01</Month><Day>09</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1532-2149</ISSN><JournalIssue CitedMedium="Internet"><Volume>23</Volume><Issue>7</Issue><PubDate><Year>2019</Year><Month>08</Month></PubDate></JournalIssue><Title>European journal of pain (London, England)</Title><ISOAbbreviation>Eur J Pain</ISOAbbreviation></Journal><ArticleTitle>Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial.</ArticleTitle><Pagination><MedlinePgn>1378-1389</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1002/ejp.1407</ELocationID><Abstract><AbstractText Label="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.</AbstractText><AbstractText Label="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.</AbstractText><AbstractText Label="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.</AbstractText><AbstractText Label="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.</AbstractText><AbstractText Label="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.</AbstractText><CopyrightInformation>© 2019 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Eklund</LastName><ForeName>Andreas</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Unit of Intervention and Implementation Research for Worker Health, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>De Carvalho</LastName><ForeName>Diana</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pagé</LastName><ForeName>Isabelle</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wong</LastName><ForeName>Arnold</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Johansson</LastName><ForeName>Melker S</ForeName><Initials>MS</Initials><AffiliationInfo><Affiliation>Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>National Research Centre for the Working Environment, Copenhagen, Denmark.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pohlman</LastName><ForeName>Katherine A</ForeName><Initials>KA</Initials><AffiliationInfo><Affiliation>Research Institute, Parker University, Dallas, Texas.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hartvigsen</LastName><ForeName>Jan</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Swain</LastName><ForeName>Michael</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Sydney, Australia.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2019</Year><Month>05</Month><Day>20</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Eur J Pain</MedlineTA><NlmUniqueID>9801774</NlmUniqueID><ISSNLinking>1090-3801</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017048" MajorTopicYN="N">Health Care Costs</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017116" MajorTopicYN="N">Low Back Pain</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName><QualifierName UI="Q000628" 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