Factors shaping expectations for complete relief from symptoms during rehabilitation for patients with spine pain.

objectivePatient expectations are related to treatment outcome across a broad variety of patient conditions. Here we sought to examine factors associated with the expectation of complete relief from treatment for spinal pain.

designSecondary analysis of data pooled from two randomized controlled trials of conservative rehabilitation interventions. PATIENTS: 252 patients (103 men, 149 women) with neck (n = 140) or back (n = 112) pain.

methodsWe used logistic regression model with backward elimination to test which patient clinical or demographic factors were most related to the expectation of complete relief.

main outcome measuresThe expectation of complete recovery, which was collected at the baseline examination visit in the primary trials.

resultsThe final model examining the contributions of patient and clinical characteristics to the expectation of complete relief included two significant interactions. First, increasing disability was associated with increased odds of expecting complete recovery in women while there was very little change for men across levels of disability (OR 0.9 [95%CI 0.8, 0.9]). Second, patients with low fear and a sudden onset of pain had higher odds of expecting recovery than patients with a gradual onset of pain (OR 0.7 [95%CI 0.5, 0.97]). A main effect for education level of the patient was also significant with better odds for expecting complete recovery for college educated patients compared to those with graduate school education (OR 5.0 [95%CI 1.9, 13.4]).

conclusionThe results should assist physical therapists to recognize patients who may have lower expectations of recovery and plan pre-treatment education interventions.