The relationship between patient and practitioner expectations and preferences and clinical outcomes in a trial of exercise and acupuncture for knee osteoarthritis
Open Access
- 1 April 2010
- journal article
- research article
- Published by Wiley in European journal of pain
- Vol. 14 (4) , 402-409
Abstract
We investigated the relationship between patient and therapist preferences and expectations and clinical outcomes in a trial of exercise and acupuncture for clinical knee osteoarthritis.352 Patients were randomised to advice and exercise or advice and exercise plus true or non‐penetrating acupuncture. Before randomisation, patients recorded their general outcome expectations, treatment‐specific preferences and expectations. Clinical outcome was (a) change scores on the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and (b) treatment response according to the OMERACT‐OARSI criteria. Physiotherapists recorded their treatment expectations and preferences for each patient following an assessment prior to randomisation. We investigated the relationship between (a) patient, (b) therapist and (c) matched patient–therapist preferences and expectations on clinical outcomes using univariate and multivariate analyses.There was no significant relationship between patients’ treatment preferences and clinical outcomes at 6 or 12months nor between patients’ expectations and pain (WOMAC) at 6 or 12months. Using our secondary outcome (OMERART‐OARSI), those who received the treatment for which they had high expectations of benefit were almost twice as likely to be classified as a treatment responder at 6months (odds ratio (OR) 1.7 (95% Confidence Interval 1.06, 2.79)) and 12months (OR) 1.9 (1.13, 3.13). Therapists’ preferences and expectations for individual patients did not add further explanation of outcomes.There was no evidence of a relationship between patients’ treatment preferences or expectations and pain reduction. We found weak evidence, from secondary outcomes, that patients’ expectations, both general and treatment‐specific, are related to clinical outcome from exercise and acupuncture.Keywords
This publication has 43 references indexed in Scilit:
- Greater Expectations: Using Hierarchical Linear Modeling to Examine Expectancy for Treatment Outcome as a Predictor of Treatment ResponseBehavior Therapy, 2008
- Patients' preferences within randomised trials: systematic review and patient level meta-analysisBMJ, 2008
- Components of placebo effect: randomised controlled trial in patients with irritable bowel syndromeBMJ, 2008
- How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapistsPain, 2008
- Beliefs and preferences: do they help determine the outcome of musculoskeletal problems?Physical Therapy Reviews, 2007
- Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trialBMJ, 2007
- Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back painBMJ, 2006
- Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preferenceBMJ, 2004
- How do patients' treatment preferences compare with those of clinicians?Quality and Safety in Health Care, 2001
- Point of ViewSpine, 2001