Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain
Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain
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DOI：
10.1097/ajp.0b013e318164aa75
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发表时间：
2008-05-01
影响因子：
2.9
通讯作者：
Vlaeyen, Johan W. S.
中科院分区：
文献类型：
--
作者：
Smeets, Rob J. E. M.;Beelen, Saskia;Vlaeyen, Johan W. S.
简介：患者对疼痛治疗成功的最初信念会影响最终的治疗结果。可信度/期望问卷（CEQ）是最近开发的一种衡量治疗可信度和期望的方法。目的：本研究的目的是：（1）通过验证性因素分析，探讨慢性下腰痛（CLBP）患者CEQ的因素结构;（2）检查治疗可信度和期望与患者特征之间的关系，方法：将167例CLBP患者随机分为3组：积极物理治疗组（n = 51）、认知行为治疗组（n = 57）和综合治疗组（n = 59），在详细解释治疗原理后完成CEQ。验证性因素分析支持CEQ的2因素结构（可信度/期望）。较低的可信度与较高的疼痛相关的恐惧和较低的内部控制的疼痛，和较低的期望与较高水平的疼痛相关的恐惧和没有辐射疼痛。多元线性回归分析显示，在控制了年龄，性别，治疗中心，基线疼痛强度，残疾持续时间，以及无论提供的治疗后，预期与残疾和满意度显着相关。可信度与患者特异性症状和满意度显著相关。对于全球感知效果，治疗预期是预测在积极的物理治疗，治疗的可信度是一个显着的预测在联合therapyonly.Discussion：虽然协会发现低到适度，这些结果强调了期望和可信度的重要性，为CLBP不同的积极干预措施的结果，并可能有助于更有效的治疗方法的发展。
Introduction: Patients' initial beliefs about the success of a given pain treatment are shown to affect final treatment outcome. The Credibility/Expectancy Questionnaire (CEQ) has recently been developed as measure of treatment credibility and expectancy.Objective: The objectives of this study were (1) to investigate the factor structure of the CEQ in a sample of chronic low back pain (CLBP) patients by means of a confirmatory factor analysis, (2) to examine the association between treatment credibility and expectancy and patient characteristics, and (3) to assess whether treatment expectancy and credibility are associated with the outcome of rehabilitation treatment.Methods: CLBP patients (n = 167) were randomized to either active physical therapy (n = 51), cognitive-behavioral therapy (n = 57), or a combination therapy (n 59), and completed the CEQ after a careful explanation of the treatment rationale.Results: Confirmatory factor analysis supported the 2-factor structure (credibility/expectancy) of the CEQ. Lower credibility was associated with higher pain-related fear and lower internal control of pain, and lower expectancy with higher levels of pain-related fear and no radiating pain. Multiple linear regression analyses revealed that after controlling for age, sex, treatment center, pain-intensity at baseline, duration of disability, and irrespective of the treatment offered, expectancy was significantly associated with disability and satisfaction. Credibility was significantly associated with patient-specific symptoms and satisfaction. For global perceived effect, treatment expectancy was predictive in active physical therapy only, and treatment credibility was a significant predictor in combination therapy only.Discussion: Although the associations found were low to modest, these results underscore the importance of expectancy and credibility for the outcome of different active interventions for CLBP and might contribute to the development of more effective treatments.