ARE PATIENT EXPECTATIONS ASSOCIATED WITH TREATMENT OUTCOMES IN
INDIVIDUALS WITH CHRONIC LOW BACK PAIN? A SYSTEMATIC REVIEW OF
RANDOMISED CONTROLLED TRIALS
Abstract
Aim The importance of patient expectations (PEs) on treatment outcomes
is poorly understood in clinical practice. The aim of this review is to
investigate the evidence behind association between pre-treatment PEs
and treatment outcomes such as pain intensity (PI), level of function
(LF) and health-related quality of life (HRQOL) among individuals with
chronic low back pain (CLBP) Methods A systematic search was conducted
for randomised controlled trials published between 1946 and May 2019
across major databases using the key MeSH terminologies. The association
between PEs and PI, LF and HRQOL were extracted and categorized into
positive, negative or no association for analysing the data. A
descriptive synthesis was conducted and the association between PEs and
PI, LF and HRQOL were reported. Results Among the total of 7 trials, 2
trials demonstrated a positive association between PEs and PI in short
(≤ 6 weeks) and long term (> 6 months), while another 2
trials demonstrated no association at medium term (> 6
weeks - ≤ 6 months). About 4 trials demonstrated a positive significant
association between PEs and LF, 2 at medium and 2 at long terms. The
only available trial demonstrated no association between PEs and HRQOL
at medium term. Conclusion Positive PEs as measured at the start of
treatment is associated with PI. Inconclusive evidence exists on the
association between PEs and LF. Limited studies show no evidence of
association between PEs and HRQOL. Further studies with valid tools to
measure PE are warranted among individuals with CLBP.