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Published in: European Spine Journal 9/2013

01-09-2013 | Original Article

How do low back pain patients conceptualize their expectations regarding treatment? Content analysis of interviews

Authors: T. M. Haanstra, L. Hanson, R. Evans, F. A. van Nes, H. C. W. De Vet, P. Cuijpers, R. W. J. G. Ostelo

Published in: European Spine Journal | Issue 9/2013

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Abstract

Purpose

The purpose of this study was to gain insight into how low back pain (LBP) patients conceptualize the construct of expectations regarding treatment.

Methods

This study was nested within a mixed-method randomized clinical trial comparing three primary care interventions for LBP. A total of 77 participants with LBP lasting longer than 6 weeks were included; semi-structured interviews were conducted querying patients about their expectations for treatment. Also factors influencing their expectations were explored. Interviews were administered following enrollment into the study, but prior to study treatment. Two researchers independently conducted a content analysis using NVIVO 9 software.

Results

LBP patients’ expectations could be categorized in two main domains: outcome and process expectations, each with subdomains. Patients expressed expectations in all subdomains both as values (what they hoped) and probabilities (what they thought was likely). In multiple subdomains, there were differences in the nature (positive vs. negative) and frequency of value and probability expectations. Participants reported that multiple factors influenced their expectations of which past experience with treatment appeared to be of major influence on probability expectations.

Conclusion and recommendations

This study showed that LBP patients’ expectations for treatment are multifaceted. Current measurement instruments do not cover all domains and subdomains of expectations. Therefore, we recommend the development of new or improved measures that make a distinction between value and probability expectations and assess process and/or outcome expectations covering multiple subdomains. Some of the influencing factors found in this study may be useful targets for altering patients’ treatment expectations and improving health outcomes.
Literature
1.
go back to reference Hoy D, Brooks P, Blyth F, Buchbinder R (2010) The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 24:769–781PubMedCrossRef Hoy D, Brooks P, Blyth F, Buchbinder R (2010) The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 24:769–781PubMedCrossRef
2.
3.
go back to reference Hoy D, March L, Brooks P, Woolf A, Blyth F, Vos T, Buchbinder R (2010) Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol 24:155–165PubMedCrossRef Hoy D, March L, Brooks P, Woolf A, Blyth F, Vos T, Buchbinder R (2010) Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol 24:155–165PubMedCrossRef
4.
go back to reference Bialosky JE, Bishop MD, Cleland JA (2010) Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain. Phys Ther 90:1345–1355PubMedCrossRef Bialosky JE, Bishop MD, Cleland JA (2010) Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain. Phys Ther 90:1345–1355PubMedCrossRef
5.
go back to reference Bishop MD, Bialosky JE, Cleland JA (2011) Patient expectations of benefit from common interventions for low back pain and effects on outcome: secondary analysis of a clinical trial of manual therapy interventions. J Man Manip Ther 19:20–25PubMedCrossRef Bishop MD, Bialosky JE, Cleland JA (2011) Patient expectations of benefit from common interventions for low back pain and effects on outcome: secondary analysis of a clinical trial of manual therapy interventions. J Man Manip Ther 19:20–25PubMedCrossRef
6.
go back to reference Foster NE, Delitto A (2011) Embedding psychosocial perspectives within clinical management of low back pain: integration of psychosocially informed management principles into physical therapist practice–challenges and opportunities. Phys Ther 91:790–803PubMedCrossRef Foster NE, Delitto A (2011) Embedding psychosocial perspectives within clinical management of low back pain: integration of psychosocially informed management principles into physical therapist practice–challenges and opportunities. Phys Ther 91:790–803PubMedCrossRef
7.
go back to reference Iles RA, Davidson M, Taylor NF, O’Halloran P (2009) Systematic review of the ability of recovery expectations to predict outcomes in non-chronic non-specific low back pain. J Occup Rehabil 19:25–40PubMedCrossRef Iles RA, Davidson M, Taylor NF, O’Halloran P (2009) Systematic review of the ability of recovery expectations to predict outcomes in non-chronic non-specific low back pain. J Occup Rehabil 19:25–40PubMedCrossRef
8.
go back to reference Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G (2006) European guidelines for the management of chronic nonspecific low back pain. Chap 4. Eur Spine J 15(Suppl 2):S192–S300PubMedCrossRef Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G (2006) European guidelines for the management of chronic nonspecific low back pain. Chap 4. Eur Spine J 15(Suppl 2):S192–S300PubMedCrossRef
9.
go back to reference van Hartingsveld F, Ostelo RWJG, Cuijpers P, de Vos R, Riphagen II, de Vet HCW (2010) Treatment-related and patient-related expectations of patients with musculoskeletal disorders: a systematic review of published measurement tools. Clin J Pain 26:470–488PubMedCrossRef van Hartingsveld F, Ostelo RWJG, Cuijpers P, de Vos R, Riphagen II, de Vet HCW (2010) Treatment-related and patient-related expectations of patients with musculoskeletal disorders: a systematic review of published measurement tools. Clin J Pain 26:470–488PubMedCrossRef
10.
go back to reference Leung KK, Silvius JL, Pimlott N, Dalziel W, Drummond N (2009) Why health expectations and hopes are different: the development of a conceptual model. Health Expect 12:347–360PubMedCrossRef Leung KK, Silvius JL, Pimlott N, Dalziel W, Drummond N (2009) Why health expectations and hopes are different: the development of a conceptual model. Health Expect 12:347–360PubMedCrossRef
11.
go back to reference Janzen JA, Silvius J, Jacobs S, Slaughter S, Dalziel W, Drummond N (2006) What is a health expectation? Developing a pragmatic conceptual model from psychological theory. Health Expect 9:37–48PubMedCrossRef Janzen JA, Silvius J, Jacobs S, Slaughter S, Dalziel W, Drummond N (2006) What is a health expectation? Developing a pragmatic conceptual model from psychological theory. Health Expect 9:37–48PubMedCrossRef
12.
go back to reference Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:191–215PubMedCrossRef Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:191–215PubMedCrossRef
13.
go back to reference Bandura A (1982) The assessment and predictive generality of self-percepts of efficacy. J Behav Ther Exp Psychiatry 13:195–199PubMedCrossRef Bandura A (1982) The assessment and predictive generality of self-percepts of efficacy. J Behav Ther Exp Psychiatry 13:195–199PubMedCrossRef
14.
go back to reference Crow R, Gage H, Hampson S, Hart J, Kimber A, Thomas H (1999) The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review. Health Technol Assess 3:1–96PubMed Crow R, Gage H, Hampson S, Hart J, Kimber A, Thomas H (1999) The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review. Health Technol Assess 3:1–96PubMed
15.
go back to reference Thompson AG, Sunol R (1995) Expectations as determinants of patient satisfaction: concepts, theory and evidence. Int J Qual Health Care 7:127–141PubMed Thompson AG, Sunol R (1995) Expectations as determinants of patient satisfaction: concepts, theory and evidence. Int J Qual Health Care 7:127–141PubMed
16.
go back to reference Kravitz RL (1996) Patients’ expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev 53:3–27PubMedCrossRef Kravitz RL (1996) Patients’ expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev 53:3–27PubMedCrossRef
17.
go back to reference Stewart-Williams S (2004) The placebo puzzle: putting together the pieces. Health Psychol 23:198–206PubMedCrossRef Stewart-Williams S (2004) The placebo puzzle: putting together the pieces. Health Psychol 23:198–206PubMedCrossRef
18.
go back to reference Iles RA, Taylor NF, Davidson M, O’Halloran PD (2012) Patient recovery expectations in non-chronic non-specific low back pain: a qualitative investigation. J Rehabil Med 44:781–787PubMedCrossRef Iles RA, Taylor NF, Davidson M, O’Halloran PD (2012) Patient recovery expectations in non-chronic non-specific low back pain: a qualitative investigation. J Rehabil Med 44:781–787PubMedCrossRef
19.
go back to reference Shaw WS, Huang YH (2005) Concerns and expectations about returning to work with low back pain: identifying themes from focus groups and semi-structured interviews. Disabil Rehabil 27:1269–1281PubMedCrossRef Shaw WS, Huang YH (2005) Concerns and expectations about returning to work with low back pain: identifying themes from focus groups and semi-structured interviews. Disabil Rehabil 27:1269–1281PubMedCrossRef
20.
go back to reference Stewart AM, Polak E, Young R, Schultz IZ (2012) Injured workers’ construction of expectations of return to work with sub-acute back pain: the role of perceived uncertainty. J Occup Rehabil 22:1–14PubMedCrossRef Stewart AM, Polak E, Young R, Schultz IZ (2012) Injured workers’ construction of expectations of return to work with sub-acute back pain: the role of perceived uncertainty. J Occup Rehabil 22:1–14PubMedCrossRef
21.
go back to reference Bronfort G, Maiers MJ, Evans RL, Schulz CA, Bracha Y, Svendsen KH, Grimm RH Jr, Owens EF Jr, Garvey TA, Transfeldt EE (2011) Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. Spine J 11:585–598PubMedCrossRef Bronfort G, Maiers MJ, Evans RL, Schulz CA, Bracha Y, Svendsen KH, Grimm RH Jr, Owens EF Jr, Garvey TA, Transfeldt EE (2011) Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. Spine J 11:585–598PubMedCrossRef
22.
go back to reference Creswell JW, Plano Clarck VL (2012) Designing and conducting mixed methods research, vol 2. SAGE publications, Los Angeles Creswell JW, Plano Clarck VL (2012) Designing and conducting mixed methods research, vol 2. SAGE publications, Los Angeles
23.
go back to reference Evans RL, Maiers MJ, Bronfort G (2003) What do patients think? Results of a mixed methods pilot study assessing sciatica patients’ interpretations of satisfaction and improvement. J Manipulative Physiol Ther 26:502–509PubMedCrossRef Evans RL, Maiers MJ, Bronfort G (2003) What do patients think? Results of a mixed methods pilot study assessing sciatica patients’ interpretations of satisfaction and improvement. J Manipulative Physiol Ther 26:502–509PubMedCrossRef
24.
go back to reference David D, Montgomery GH, Stan R, Dilorenzo T, Erblich J (2004) Discrimination between hopes and expectancies for nonvolitional outcomes: psychological phenomenon or artifact? Pers Individ Dif 36:1945–1952PubMedCrossRef David D, Montgomery GH, Stan R, Dilorenzo T, Erblich J (2004) Discrimination between hopes and expectancies for nonvolitional outcomes: psychological phenomenon or artifact? Pers Individ Dif 36:1945–1952PubMedCrossRef
25.
go back to reference Montgomery GH, David D, Dilorenzo T, Erblich J (2003) Is hoping the same as expecting? Discrimination between hopes and response expectancies for nonvolitional outcomes. Pers Individ Dif 35:399–409PubMedCrossRef Montgomery GH, David D, Dilorenzo T, Erblich J (2003) Is hoping the same as expecting? Discrimination between hopes and response expectancies for nonvolitional outcomes. Pers Individ Dif 35:399–409PubMedCrossRef
26.
go back to reference Main CJ, Foster N, Buchbinder R (2010) How important are back pain beliefs and expectations for satisfactory recovery from back pain? Best Pract Res Clin Rheumatol 24:205–217PubMedCrossRef Main CJ, Foster N, Buchbinder R (2010) How important are back pain beliefs and expectations for satisfactory recovery from back pain? Best Pract Res Clin Rheumatol 24:205–217PubMedCrossRef
27.
go back to reference Elwyn G, Edwards A, Kinnersley P (1999) Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract 49:477–482PubMed Elwyn G, Edwards A, Kinnersley P (1999) Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract 49:477–482PubMed
Metadata
Title
How do low back pain patients conceptualize their expectations regarding treatment? Content analysis of interviews
Authors
T. M. Haanstra
L. Hanson
R. Evans
F. A. van Nes
H. C. W. De Vet
P. Cuijpers
R. W. J. G. Ostelo
Publication date
01-09-2013
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 9/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-013-2803-8

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