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Expectation of Recovery From Low Back Pain: A Longitudinal Cohort Study Investigating Patient Characteristics Related to Expectations and the Association Between Expectations and 3-Month Outcome

Kongsted, Alice PhD*; Vach, Werner PhD*,†; Axø, Marie MSc(Clin Biomech); Bech, Rasmus Nørgaard MSc(Clin Biomech); Hestbaek, Lise PhD*,‡

doi: 10.1097/BRS.0000000000000059
Health Services Research

Study Design. A prospective cohort study conducted in general practice (GP) and chiropractic practice (CP).

Objective. To explore which patient characteristics were associated with recovery expectations in patients with low back pain (LBP), whether expectations predicted 3-month outcome, and to what extent expectations were associated with empirical prognostic factors.

Summary of Background Data. Patients' recovery expectations have been associated with prognosis, but it is largely unknown why patients expect what they do, and how expectations relate to other prognostic factors.

Methods. A total of 1169 participants completed questionnaires at their first consultation due to LBP, and 78% were followed for 3 months. At baseline, recovery expectations were measured on a 0 to 10 scale. Outcome measures were LBP intensity and global perceived effect. Associations were tested in regression models, and the predictive capacity of expectations described in terms of adjusted R2 and area under the receiver operating characteristic curve. Correlations between predicted expectations and prognosis were quantified by the Spearman rho.

Results. Expectations were associated with known prognostic factors, mainly LBP history, but were only partly explained by measured factors (adjusted R2, 35% [CP]/55% [GP]). Expectations had statistically significant associations with both outcomes after adjusting for other baseline factors, but explained only a little of the variance in LBP (adjusted R2: 0.11 CP/0.32 GP) and did not add to the explained variance. The prediction of global perceived effect was limited in CP (area under the receiver operating characteristics curve, 0.59), but more substantial in GP (area under the receiver operating characteristics curve, 0.77) patients. Correlations between predicted expectations and predicted outcome were strong.

Conclusion. Patients' recovery expectations were associated mainly with LBP history and were generally, but not consistently, similar to an empirically predicted prognosis. Expectations were significantly associated with outcome, and may, at least for some outcomes, be a relevant proxy for more complex models. Future studies should explore the effect of addressing negative recovery expectations.

Level of Evidence: 2

Recovery expectations in primary care patients with low back pain (LBP) were closer related to previous LBP experience than to symptom severity and the considered psychological factors. Expectations had an association with outcome independent of other measured factors and were generally a good proxy for other prognostic factors.

*Nordic Institute of Chiropractic and Clinical Biomechanics, part of Clinical Locomotion Network, Odense, Denmark

Institute of Medical Biometry and Medical Informatics, University of Freiburg, Freiburg, Germany; and

Institute of Sports Science and Clinical Biomechanics, part of Clinical Locomotion Network, University of Southern Denmark, Odense, Denmark.

Address correspondence and reprint requests to Alice Kongsted, PhD, Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB), Campusvej 55, 5230 Odense M, Denmark; E-mail:

Acknowledgment date: March 5, 2013. Revision date: August 15, 2013. Acceptance date: September 23, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Danish Chiropractors' Foundation and IMK Almene Fond grant funds were received in support of this work. The Nordic Institute of Chiropractic and Clinical Biomechanics is financed by the Danish Chiropractors' Foundation.

Relevant financial activities outside the submitted work: employment, expert testimony, and grants.

© 2014 by Lippincott Williams & Wilkins