Kalauokalani D, Cherkin D C, Sherman K J, Koepsell T D, Deyo R A
Washington University Pain Center, St.Louis, MO, USA.
Spine (Phila Pa 1976). 2001 Jul 1;26(13):1418-24. doi: 10.1097/00007632-200107010-00005.
A subanalysis of data derived from a randomized clinical trial was performed.
To evaluate the association of a patient's expectation for benefit from a specific treatment with improved functional outcome.
Psychosocial factors, ambiguous diagnoses, and lack of a clearly superior treatment have complicated the management of patients with chronic low back pain. The authors hypothesized that patient expectation for benefit from a specific treatment is associated with improved functional outcomes when that treatment is administered.
In a randomized trial, 135 patients with chronic low back pain who received acupuncture or massage were studied. Before randomization, study participants were asked to describe their expectations regarding the helpfulness of each treatment on a scale of 0 to 10. The primary outcome was level of function at 10 weeks as measured by the modified Roland Disability scale.
After adjustment for baseline characteristics, improved function was observed for 86% of the participants with higher expectations for the treatment they received, as compared with 68% of those with lower expectations (P = 0.01). Furthermore, patients who expected greater benefit from massage than from acupuncture were more likely to experience better outcomes with massage than with acupuncture, and vice versa (P = 0.03).
The results of this study suggest that patient expectations may influence clinical outcome independently of the treatment itself. In contrast, general optimism about treatment, divorced from a specific treatment, is not strongly associated with outcome. These results may have important implications for clinical trial design and recruitment, and may help to explain the apparent success of some conventional and alternative therapies in trials that do not control for patient expectations. The findings also may be important for therapy choices made in the clinical setting.
对一项随机临床试验所得数据进行了亚组分析。
评估患者对特定治疗获益的期望与功能改善结果之间的关联。
社会心理因素、诊断不明确以及缺乏明显更优的治疗方法使慢性下腰痛患者的管理变得复杂。作者推测，当给予特定治疗时，患者对该治疗获益的期望与功能改善结果相关。
在一项随机试验中，对135例接受针灸或按摩治疗的慢性下腰痛患者进行了研究。在随机分组前，研究参与者被要求在0至10的量表上描述他们对每种治疗有效性的期望。主要结局是10周时用改良罗兰残疾量表测量的功能水平。
在对基线特征进行调整后，对所接受治疗期望较高的参与者中有86%的功能得到改善，而期望较低的参与者中这一比例为68%（P = 0.01）。此外，期望按摩比针灸更有益的患者接受按摩时比接受针灸时更有可能获得更好的结果，反之亦然（P = 0.03）。
本研究结果表明，患者期望可能独立于治疗本身影响临床结局。相比之下，与特定治疗无关的对治疗的总体乐观态度与结局的关联并不紧密。这些结果可能对临床试验设计和招募具有重要意义，并且可能有助于解释在未控制患者期望的试验中一些传统和替代疗法明显成功的原因。这些发现对于临床环境中的治疗选择也可能很重要。
