Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial
Open accessAbstract
BACKGROUND: Low back pain (LBP) is a global public health challenge, which causes high healthcare costs and the highest burden on society in terms of years lived with disability. While patients' expectations for improvement may have effects on LBP treatment outcomes, it remains unclear if psychological profiles modify this relationship. Therefore, the objectives of this study were to investigate if (a) patients' expectations predicted short-term outcome, and (b) psychological profile, pain intensity and self-rated health modified the relationship between expectations and outcome. METHODS: Data were collected between April 2012 and January 2016 during the inclusion into a randomized controlled trial. Potentially eligible participants were identified through 40 chiropractic clinics located across Sweden. Patients' expectations, psychological profile, pain intensity, activity limitation and self-rated health were collected from patients with recurrent persistent LBP during their first chiropractic visit (n = 593). Subjective improvement was measured at the fourth visit. RESULTS: Patients with a high expectation of improvement had 58% higher risk to report an improvement at the fourth visit (RR = 1.58, 95% CI: 1.28, 1.95). Controlling for potential confounders only slightly decreased the strength of this association (RR = 1.49, 95% CI: 1.20, 1.86). Baseline pain intensity, psychological profile and self-rated health did not modify the effect of expectation on outcome. CONCLUSIONS: Baseline patients' expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patients' expectations at the first visit to best inform prognosis. SIGNIFICANCE: This study confirms the importance of patients' expectations in a clinical setting. Patients' expectations predict the short-term outcome of chiropractic care for LBP. Pain intensity, psychological profile and self-rated health did not modify this relationship.
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Higher expectations about treatment outcomes have been associated with improvements after treatment for chronic pain.
“Higher expectations about treatment outcomes have been associated with improvements after treatment for chronic pain. 47”
From Internet-based treatment for provoked vulvodynia: Factors associated with treatment outcomes (2025) · cites this paper as [47]
The Results and Discussion report that patients with higher expectations of improvement were more likely to report improved low back pain at the fourth visit. The Methods specify recurrent, persistent low back pain, defined in part as more than 30 days of pain in the past year; the study does not establish this association for chronic pain generally. (LLM, conf=0.85)
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I expect what you expect: An electrophysiological study on social expectation of pain
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Low Back Pain Physiotherapy: Does Expectation Really Influence Outcome?
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- Authors
- Eklund, A., De Carvalho, D., Pagé, I., Wong, A., Johansson, M. S., Pohlman, K. A., Hartvigsen, J., & Swain, M.
- Affiliations
- Karolinska Institutet (SE)
- Discipline of Medicine, Faculty of Medicine Memorial University of Newfoundland St. John's Newfoundland and Labrador Canada
- Université du Québec à Trois-Rivières (CA)
- Hong Kong Polytechnic University (HK)
- University of Southern Denmark (DK)
- Parker University (US)
- The University of Sydney (AU)
- Corresponding author
- Eklund, Andreas
- ORCID
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2019-05-20
- Volume
- 23
- Issue
- 7
- Pages
- 1378-1389
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- PMC
- PMC6767754
- OpenAlex
- W2943258756
- Cited by
- 76
- References
- 67
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 16 · 2023: 11 · 2022: 8 · 2021: 9 · 2020: 9 · 2019: 1
- FWCI
- 4.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Pain (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (acceptedVersion, cc-by-nc-nd)
- PolyU Institutional Research Archive (Hong Kong Polytechnic University) (submittedVersion, cc-by-nc-nd)
- Funders
- European Chiropractors' Union
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- low back pain, patient expectations, chiropractic, treatment outcomes, psychological profile, pain intensity, self-rated health, activity limitation, prognosis
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Motivation, Pain Measurement, Prognosis, Randomized Controlled Trials as Topic, Treatment Outcome, Health Care Costs, Low Back Pain, Manipulation, Chiropractic
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