Unit of Intervention and Implementation Research for Worker Health, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
Eur J Pain. 2019 Aug;23(7):1378-1389. doi: 10.1002/ejp.1407. Epub 2019 May 20.
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.
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.
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.
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.
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.
下腰痛（LBP）是一个全球性的公共卫生挑战，它导致了高昂的医疗保健成本，并在残疾年限方面给社会带来了最大的负担。虽然患者的改善期望可能对 LBP 治疗结果有影响，但目前尚不清楚心理特征是否会改变这种关系。因此，本研究的目的是调查（a）患者的期望是否能预测短期结果，以及（b）心理特征、疼痛强度和自我评估健康是否能改变期望与结果之间的关系。
数据收集于 2012 年 4 月至 2016 年 1 月期间，在一项随机对照试验中进行。通过位于瑞典各地的 40 家脊骨疗法诊所确定潜在的合格参与者。在脊骨疗法的首次就诊期间，从患有复发性持续性 LBP 的患者中收集患者的期望、心理特征、疼痛强度、活动受限和自我评估健康（n=593）。在第四次就诊时测量主观改善情况。
期望改善的患者在第四次就诊时报告改善的风险高 58%（RR=1.58，95%CI：1.28，1.95）。仅控制潜在混杂因素略微降低了这种关联的强度（RR=1.49，95%CI：1.20，1.86）。基线疼痛强度、心理特征和自我评估健康并未改变期望对结果的影响。
基线患者的期望在预测 LBP 治疗结果方面起着重要作用。临床医生应在首次就诊时考虑并解决患者的期望，以最佳地告知预后。
本研究证实了患者期望在临床环境中的重要性。患者的期望预测了脊骨疗法治疗 LBP 的短期结果。疼痛强度、心理特征和自我评估健康并未改变这种关系。
