STUDY DESIGN: Retrospective cohort. OBJECTIVES: The objectives of this study were to 1) examine patients' general expectations for treatment by physical therapists and specific expectations for common interventions in patients with neck pain; and 2) assess the extent to which the patients' general and specific expectations for treatment affect clinical outcomes. BACKGROUND: Patient expectations can have a profound influence on the magnitude of treatment outcome across a broad variety of patient conditions. METHODS: We performed a secondary analysis of data from a clinical trial of interventions for neck pain. Prior to beginning treatment for neck pain, 140 patients were asked their general expectations of benefit as well as their specific expectations for individual interventions. Next we examined how these expectations related to the patients' ratings of the success of treatment at one and six months after treatment. RESULTS: Patients had positive expectations for treatment by a physical therapist with more than 80% of patients expecting to have moderate relief of symptoms, prevention of disability, the ability to do more activity, and to sleep better. The manual therapy interventions of massage (87%) and manipulation (75%) had the highest proportion of patients who expected these interventions to significantly improve neck pain. These were followed by strengthening (70%) and range of motion (54%) exercises. Very few patients thought surgery would improve their neck pain (<1%). At 1-month, patients who were unsure of experiencing complete pain relief had lower odds than patients expecting complete relief (OR 0.33, 95%CI 0.11, 0.99). Believing that manipulation would help and not receiving manipulation lowered the odds of success (OR 0.16, 95%CI 0.04, 0.72) compared to believing manipulation would help and receiving manipulation. Six months after treatment, having unsure expectations for complete pain relief lowered the odds of success 0.19 (95%CI 0.05, 0.7) times while definitely expecting to do more exercise increased odds of success (OR 11.4, 95%CI 1.7, 74.7) times. When considering self-reported disability, patients who believed manipulation would help and received manipulation reported less disability than those who didn't believe manipulation would help and both received manipulation (difference of -3.8, 95%CI -5.9, -1.5; p=0.006) and did not receive manipulation (difference of -5.7, 95%CI -9.3, -2.1; p=0.014). There was also an interaction between time and the expectation for complete relief. Here, participants who expected complete relief had greater changes in disability at 1-month (20.3% 95%CI 18.1, 22.6) compared to those participants who did not expect complete relief (14.1%, 95%CI 11.1, 17.0; p=0.014). CONCLUSION: General expectations of benefit have a strong influence on clinical outcomes for patients with neck pain. LEVEL OF EVIDENCE: Prognosis, level 2b.
J Orthop Sports Phys Ther, Epub 18 March 2013. doi:10.2519/jospt.2013.4492
KEY WORDS: exercise, manual therapy, neck pain, outcomes