Grace Hsiao-Wei Lo1, Ajay S Balasubramanyam2, Andrea Barbo3, Richard L Street4, Maria E Suarez-Almazor3. 1. Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. 2. Texas A&M University Health Science Center, College Station. 3. University of Texas MD Anderson Cancer Center, Houston. 4. Texas A&M University, College Station, and Baylor College of Medicine, Houston.
Abstract
OBJECTIVE: A prior knee osteoarthritis (OA) trial found that provider-conveyed expectations for treatment success were associated with pain improvement. We hypothesized this relationship was mediated by patient self-efficacy, since expectations of improvement may enhance one's ability to control health behaviors, and therefore health. Our aim was to examine whether self-efficacy was a mediator of the relationship observed in this trial. METHODS: A secondary analysis of a 3-arm (traditional acupuncture, sham acupuncture, and wait list) trial for knee OA was conducted. Those in the acupuncture groups were equally randomized to acupuncturists trained to communicate a high or neutral expectation of treatment success (e.g., using language conveying high or unclear likelihood that acupuncture would reduce knee pain). A modified Arthritis Self-Efficacy Questionnaire and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale were administered. Linear regression analyses were used to examine whether patient self-efficacy mediated the relationship between provider communication style and knee pain at 3 months. RESULTS: High-expectation provider communication was associated with patient self-efficacy, β coefficient of 0.14 (95% confidence interval [95% CI] 0.01, 0.28). Self-efficacy was associated with WOMAC pain, β coefficient of -9.29 (95% CI -11.11, -7.47), while controlling for the provider communication style. The indirect effect a × b of -1.36 for high versus neutral expectation (bootstrap 95% CI -2.80, -0.15; does not include 0), supports the conclusion that patient self-efficacy mediates the relationship between provider-communicated expectations of treatment effects and knee pain. CONCLUSION: Our findings suggest that clinician-conveyed expectations can enhance the benefit of treatments targeting knee OA symptoms, mediated by improved patient self-efficacy.
RCT Entities:
OBJECTIVE: A prior knee osteoarthritis (OA) trial found that provider-conveyed expectations for treatment success were associated with pain improvement. We hypothesized this relationship was mediated by patient self-efficacy, since expectations of improvement may enhance one's ability to control health behaviors, and therefore health. Our aim was to examine whether self-efficacy was a mediator of the relationship observed in this trial. METHODS: A secondary analysis of a 3-arm (traditional acupuncture, sham acupuncture, and wait list) trial for knee OA was conducted. Those in the acupuncture groups were equally randomized to acupuncturists trained to communicate a high or neutral expectation of treatment success (e.g., using language conveying high or unclear likelihood that acupuncture would reduce knee pain). A modified Arthritis Self-Efficacy Questionnaire and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale were administered. Linear regression analyses were used to examine whether patient self-efficacy mediated the relationship between provider communication style and knee pain at 3 months. RESULTS: High-expectation provider communication was associated with patient self-efficacy, β coefficient of 0.14 (95% confidence interval [95% CI] 0.01, 0.28). Self-efficacy was associated with WOMACpain, β coefficient of -9.29 (95% CI -11.11, -7.47), while controlling for the provider communication style. The indirect effect a × b of -1.36 for high versus neutral expectation (bootstrap 95% CI -2.80, -0.15; does not include 0), supports the conclusion that patient self-efficacy mediates the relationship between provider-communicated expectations of treatment effects and knee pain. CONCLUSION: Our findings suggest that clinician-conveyed expectations can enhance the benefit of treatments targeting knee OA symptoms, mediated by improved patient self-efficacy.
Authors: Mallory O Johnson; Margaret A Chesney; Rise B Goldstein; Robert H Remien; Sheryl Catz; Cheryl Gore-Felton; Edwin Charlebois; Stephen F Morin Journal: AIDS Patient Care STDS Date: 2006-04 Impact factor: 5.078
Authors: Amy S Chappell; Durisala Desaiah; Hong Liu-Seifert; Shuyu Zhang; Vladimir Skljarevski; Yuri Belenkov; Jacques P Brown Journal: Pain Pract Date: 2011 Jan-Feb Impact factor: 3.183
Authors: Reva C Lawrence; David T Felson; Charles G Helmick; Lesley M Arnold; Hyon Choi; Richard A Deyo; Sherine Gabriel; Rosemarie Hirsch; Marc C Hochberg; Gene G Hunder; Joanne M Jordan; Jeffrey N Katz; Hilal Maradit Kremers; Frederick Wolfe Journal: Arthritis Rheum Date: 2008-01
Authors: W Zhang; R W Moskowitz; G Nuki; S Abramson; R D Altman; N Arden; S Bierma-Zeinstra; K D Brandt; P Croft; M Doherty; M Dougados; M Hochberg; D J Hunter; K Kwoh; L S Lohmander; P Tugwell Journal: Osteoarthritis Cartilage Date: 2008-02 Impact factor: 6.576
Authors: Gregory Kanter; Katherine A Volpe; Gena C Dunivan; Sara B Cichowski; Peter C Jeppson; Rebecca G Rogers; Yuko M Komesu Journal: Int Urogynecol J Date: 2016-08-31 Impact factor: 2.894
Authors: Emily Lyness; Jane Louise Vennik; Felicity L Bishop; Pranati Misurya; Jeremy Howick; Kirsten A Smith; Mohana Ratnapalan; Stephanie Hughes; Hajira Dambha-Miller; Jennifer Bostock; Leanne Morrison; Christian D Mallen; Lucy Yardley; Geraldine Leydon; Paul Little; Hazel Everitt Journal: BJGP Open Date: 2021-06-30
Authors: Eleuterio A Sánchez Romero; Tifanny Lim; Jorge Hugo Villafañe; Gurvan Boutin; Victor Riquelme Aguado; Aitor Martin Pintado-Zugasti; José Luis Alonso Pérez; Josué Fernández Carnero Journal: Int J Environ Res Public Health Date: 2021-04-15 Impact factor: 3.390