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Chiropractic Research Review

Benefits of LBP Treatment Related to Patient Expectations

Low back pain (LBP) is one of the primary reasons people seek non-medical forms of treatment. Psychological factors may profoundly affect the results of treatment, because patients approach pain and pain treatments with many different viewpoints.

The purpose of this study was to determine if patient expectations of treatment benefits were related to treatment outcomes.

Researchers randomly assigned 135 patients, aged 20 to 70 and suffering from chronic LBP, into either an acupuncture or a massage treatment group. Prior to the randomization, patients rated how helpful they expected each treatment to be on a scale from 0 (not at all helpful) to 10 (extremely helpful). The same questions were asked after a 10-week treatment period by use of a telephone follow-up. The functional ability of each patient was determined using a 23-point modified Roland Disability scale. A change of two points between initial and follow-up assessment using this scale was used to determine improvement, as that amount of change is considered clinically significant.

The study yielded several results:

* 86% of the participants with higher expectations for their treatment demonstrated an improved Roland Morris Disability score; only 68% of patients with low expectations demonstrated improvements on the same scale.
* Odds of improvement were five times greater for the high-expectation group than the low-expectation group, after adjusting for other factors, such as physical health, age, education, etc.
* Patients who expected benefit from one treatment, as opposed to the other, improved more from that particular treatment.
* Changes in mental health-status scores were much greater in the high-expectation group than in the low-expectation group after treatment.

"The results of this study suggest that patient expectations may influence clinical outcome independently of the treatment itself," the authors write. The study suggests a need for assessing patient expectations in clinical studies of chronic pain.

Take Note: This study nicely points out that patients who have an expectation to benefit from care tend to demonstrate a better clinical outcome. Studies such as this help to explain the non-specific effects of some treatments.

Kalauokalani D, Cherkin DC, Sherman KJ, et al. Lessons from a trial of acupuncture and massage for low back pain: Patient expectations and treatment effects. Spine, July 1, 2001:26(13), pp. 1418-1424.

Chiropractic Research Review

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