Alice Kongsted1, Werner Vach, Marie Axø, Rasmus Nørgaard Bech, Lise Hestbaek. 1. *Nordic Institute of Chiropractic and Clinical Biomechanics, part of Clinical Locomotion Network, Odense, Denmark †Institute of Medical Biometry and Medical Informatics, University of Freiburg, Freiburg, Germany; and ‡Institute of Sports Science and Clinical Biomechanics, part of Clinical Locomotion Network, University of Southern Denmark, Odense, Denmark.
Abstract
STUDY DESIGN: A prospective cohort study conducted in general practice (GP) and chiropractic practice (CP). OBJECTIVE: To explore which patient characteristics were associated with recovery expectations in patients with low back pain (LBP), whether expectations predicted 3-month outcome, and to what extent expectations were associated with empirical prognostic factors. SUMMARY OF BACKGROUND DATA: Patients' recovery expectations have been associated with prognosis, but it is largely unknown why patients expect what they do, and how expectations relate to other prognostic factors. METHODS: A total of 1169 participants completed questionnaires at their first consultation due to LBP, and 78% were followed for 3 months. At baseline, recovery expectations were measured on a 0 to 10 scale. Outcome measures were LBP intensity and global perceived effect. Associations were tested in regression models, and the predictive capacity of expectations described in terms of adjusted R and area under the receiver operating characteristic curve. Correlations between predicted expectations and prognosis were quantified by the Spearman rho. RESULTS: Expectations were associated with known prognostic factors, mainly LBP history, but were only partly explained by measured factors (adjusted R, 35% [CP]/55% [GP]). Expectations had statistically significant associations with both outcomes after adjusting for other baseline factors, but explained only a little of the variance in LBP (adjusted R: 0.11 CP/0.32 GP) and did not add to the explained variance. The prediction of global perceived effect was limited in CP (area under the receiver operating characteristics curve, 0.59), but more substantial in GP (area under the receiver operating characteristics curve, 0.77) patients. Correlations between predicted expectations and predicted outcome were strong. CONCLUSION: Patients' recovery expectations were associated mainly with LBP history and were generally, but not consistently, similar to an empirically predicted prognosis. Expectations were significantly associated with outcome, and may, at least for some outcomes, be a relevant proxy for more complex models. Future studies should explore the effect of addressing negative recovery expectations. LEVEL OF EVIDENCE: 2.
STUDY DESIGN: A prospective cohort study conducted in general practice (GP) and chiropractic practice (CP). OBJECTIVE: To explore which patient characteristics were associated with recovery expectations in patients with low back pain (LBP), whether expectations predicted 3-month outcome, and to what extent expectations were associated with empirical prognostic factors. SUMMARY OF BACKGROUND DATA: Patients' recovery expectations have been associated with prognosis, but it is largely unknown why patients expect what they do, and how expectations relate to other prognostic factors. METHODS: A total of 1169 participants completed questionnaires at their first consultation due to LBP, and 78% were followed for 3 months. At baseline, recovery expectations were measured on a 0 to 10 scale. Outcome measures were LBP intensity and global perceived effect. Associations were tested in regression models, and the predictive capacity of expectations described in terms of adjusted R and area under the receiver operating characteristic curve. Correlations between predicted expectations and prognosis were quantified by the Spearman rho. RESULTS: Expectations were associated with known prognostic factors, mainly LBP history, but were only partly explained by measured factors (adjusted R, 35% [CP]/55% [GP]). Expectations had statistically significant associations with both outcomes after adjusting for other baseline factors, but explained only a little of the variance in LBP (adjusted R: 0.11 CP/0.32 GP) and did not add to the explained variance. The prediction of global perceived effect was limited in CP (area under the receiver operating characteristics curve, 0.59), but more substantial in GP (area under the receiver operating characteristics curve, 0.77) patients. Correlations between predicted expectations and predicted outcome were strong. CONCLUSION:Patients' recovery expectations were associated mainly with LBP history and were generally, but not consistently, similar to an empirically predicted prognosis. Expectations were significantly associated with outcome, and may, at least for some outcomes, be a relevant proxy for more complex models. Future studies should explore the effect of addressing negative recovery expectations. LEVEL OF EVIDENCE: 2.
Authors: Jason M Beneciuk; Jonathan C Hill; Paul Campbell; Ebenezer Afolabi; Steven Z George; Kate M Dunn; Nadine E Foster Journal: J Pain Date: 2016-10-17 Impact factor: 5.820
Authors: Jeffrey G Jarvik; Bryan A Comstock; Patrick J Heagerty; Judith A Turner; Sean D Sullivan; Xu Shi; David R Nerenz; Srdjan S Nedeljkovic; Larry Kessler; Kathryn James; Janna L Friedly; Brian W Bresnahan; Zoya Bauer; Andrew L Avins; Richard A Deyo Journal: BMC Musculoskelet Disord Date: 2014-04-23 Impact factor: 2.362
Authors: Lise Hestbaek; Anders Munck; Lisbeth Hartvigsen; Dorte Ejg Jarbøl; Jens Søndergaard; Alice Kongsted Journal: Int J Family Med Date: 2014-11-04