Patient Expectations of Benefit from Interventions for Neck Pain and Resulting Influence on Outcomes.

Patient expectations can have a significant influence on the magnitude of treatment outcome across a wide range of patient conditions.  The goals of this retrospective cohort study was to 1) examine patients’ general expectations for treatment by physical therapists and specific expectations for common interventions in patients with neck pain; and 2) assess the degree to which the patients’ general and specific expectations for treatment affect clinical outcomes.  The study used a secondary analysis of data from a clinical trial of interventions for neck pain. Before beginning treatment for neck pain, 140 patients were asked their general expectations of benefit as well as their specific expectations for individual interventions. Patients had positive expectations for treatment by a physical therapist with more than 80% of patients expecting to have moderate relief of symptoms, prevention of disability, the ability to do more activity, and to sleep better. The manual therapy interventions of massage and manipulation had the highest proportion of patients who expected these interventions to significantly improve neck pain. After these were strengthening and range of motion exercises. Not many patients thought surgery would improve their neck pain. At 1-month, patients who were unsure of experiencing complete pain relief had lower odds than patients expecting complete relief. Believing that manipulation would help and not receiving manipulation lowered the odds of success compared to believing manipulation would help and receiving manipulation. Six months after treatment, having unsure expectations for complete pain relief lowered the odds of success 0.19 times while definitely expecting to do more exercise increased odds of success times. When considering self-reported disability, patients who believed manipulation would help and received manipulation reported less disability than those who didn’t believe manipulation would help and both received manipulation and did not receive manipulation. There was also an interaction between time and the expectation for complete relief. Here, participants who expected complete relief had greater changes in disability at 1-month compared to those participants who did not expect complete relief.

The study found that general expectations of benefit have a pronounced influence on clinical outcomes for patients with neck pain.