The influence of expectations on improvements in pain and function in patients with neck/back/shoulder complaints: a cohort study.

BACKGROUND

In musculoskeletal research, patients' expectations have recently received increased attention. However, few prospective studies have investigated these expectations or their prognostic significance and possible clinical value.

AIM

To investigate the influence of patients' expectations on improvements in pain and functional status six months after an outpatient physical medicine assessment.

DESIGN

Prospective cohort study.

SETTING

Physical Medicine and Rehabilitation (PMR) outpatient clinic.

POPULATION

Patients with neck, back, or shoulder complaints.

METHODS

Pain, during rest and activity, and functional status (PainFunction) were assessed using numerical rating scales (NRSs; 0 to 11) prior to a PMR consultation and after six months. At baseline, the patients were asked to define their expectations (Exp) regarding pain and functional status at six months using equivalent NRSs. The influence of Exp on PainFunction at six months was assessed through multiple regression analysis, controlling for demographic factors.

RESULTS

A total of 256 patients were included between January and June 2013, and 181 were followed up at six months. PainFunction improved statistically significant between baseline and six months (P<0.001). Approximately 40% of the patients expected (Exp) an improvement, while 29% reported an improvement at six months, reflected by a minimum of two points improvement in PainFunction. The regression analysis revealed that sick leave and the number of pain sites, but not expectations (Exp), influenced improvement in PainFunction at six months.

CONCLUSIONS

The present study does not support the suggested influence of expectations on pain and functional improvement in patients with neck, back or shoulder complaints.

CLINICAL REHABILITATION IMPACT

The patients' expectations were more positive than their actual pain and functional improvements. However, their expectations did not significantly influence the study outcomes.