Factors shaping expectations for complete relief from symptoms during rehabilitation for patients with spine pain

ABSTRACT

Objective: Patient expectations are related to treatment outcome across a broad variety of patient conditions. Here we sought to examine factors associated with the expectation of complete relief from treatment for spinal pain. Design: Secondary analysis of data pooled from two randomized controlled trials of conservative rehabilitation interventions. Patients: 252 patients (103 men, 149 women) with neck (n = 140) or back (n = 112) pain. Methods: We used logistic regression model with backward elimination to test which patient clinical or demographic factors were most related to the expectation of complete relief. Main Outcome Measures: The expectation of complete recovery, which was collected at the baseline examination visit in the primary trials. Results: The final model examining the contributions of patient and clinical characteristics to the expectation of complete relief included two significant interactions. First, increasing disability was associated with increased odds of expecting complete recovery in women while there was very little change for men across levels of disability (OR 0.9 [95%CI 0.8, 0.9]). Second, patients with low fear and a sudden onset of pain had higher odds of expecting recovery than patients with a gradual onset of pain (OR 0.7 [95%CI 0.5, 0.97]). A main effect for education level of the patient was also significant with better odds for expecting complete recovery for college educated patients compared to those with graduate school education (OR 5.0 [95%CI 1.9, 13.4]). Conclusion: The results should assist physical therapists to recognize patients who may have lower expectations of recovery and plan pre-treatment education interventions.

KEYWORDS:

• Disability
• manual therapy
• outcomes
• pain
• spinal manipulation

Acknowledgments

The original trials on which this current work was based were directly supported by the Foundation for Physical Therapy, the Orthopaedic Section of the American Physical Therapy Association and an American Academy of Orthopaedic Manual Physical Therapists Cardon Rehabilitation Products Grant. MDB and JEB received support from the National Center of Complementary and Integrative Health (AT006334).

Declaration of Interest

The authors indicate no conflict of interest.