The impact of treatment confidence on pain and related disability among patients with low-back pain: results from the University of California, Los Angeles, low-back pain study.
The impact of treatment confidence on pain and related disability among patients with low-back pain: results from the University of California, Los Angeles, low-back pain study.
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DOI：
10.1016/s1529-9430(02)00414-x
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发表时间：
2002-11-01
期刊：
影响因子：
--
通讯作者：
Yu, Fei
中科院分区：
文献类型：
--
作者：
Goldstein, Michael S;Morgenstern, Hal;Yu, Fei
背景背景：尽管许多研究人员和从业人员认为患者对治疗的积极期望会影响临床结果，但很少有科学证据支持这一观点。目的：通过治疗组和其他因素描述患者对其指定治疗成功的初始信心水平；并评估治疗信心对腰痛和相关残疾的后续变化的影响。研究设计和患者样本：一项随机临床试验，涉及681名在南加州一家管理护理机构治疗腰痛的患者。结局指标：治疗信心；以及腰痛的三个临床指标的变化：平均疼痛、最严重疼痛和与背痛相关的残疾。方法：患者被随机分配到四个治疗组中的一个：有和没有物理治疗的医疗护理组，有和没有物理治疗的捏脊护理组。在基线、2周、6周和6个月时通过问卷收集信息。治疗置信度在随机化后以0到10的等级进行测量。结果：平均而言，仅接受医疗护理的患者治疗信心最低，接受医疗护理加物理治疗的患者治疗信心最高。其他对治疗信心较高的预测因素是急性疼痛、年龄较大、女性和非白人。尽管在整个样本中，治疗信心仅与随后腰痛或残疾的变化弱相关，但在接受医疗护理加物理治疗的患者中，高治疗信心与更大的改善相关。结论：腰痛治疗的初始信心因治疗类型和其他因素而异。较高的信心可能对某些患者的腰痛病程有一些有益的影响，但这种影响可能取决于病人和提供者之间的互动类型。
BACKGROUND CONTEXT: Although many researchers and practitioners believe that patients' positive expectations of their treatment favorably influence clinical outcomes, there is little scientific evidence to support this belief.PURPOSE: To describe the level of patients' initial confidence in the success of their assigned treatment, by treatment group and other factors; and to estimate the effects of treatment confidence on subsequent changes in low-back pain and related disability. STUDY DESIGN AND PATIENT SAMPLE: Randomized clinical trial involving 681 patients treated for low-back pain in a managed-care facility in Southern California.OUTCOME MEASURES: Treatment confidence; and changes in three clinical measures of low-back pain: average pain, most severe pain and back-pain-related disability.METHODS: Patients were randomly assigned to one of four treatment groups: medical care with and without physical therapy, and chiropractic care with and without physical modalities. Information was collected by questionnaires at baseline, 2 weeks, 6 weeks and 6 months. Treatment confidence was measured just after randomization on a scale of 0 to 10.RESULTS: Treatment confidence was lowest, on average, for patients assigned to medical care only and highest for patients assigned to medical care plus physical therapy. Other predictors of high treatment confidence were having acute pain and being older, female and nonwhite. Although treatment confidence was only weakly associated with subsequent changes in low-back pain or disability in the total sample, high treatment confidence was associated with greater improvement among patients assigned to medical care plus physical therapy.CONCLUSIONS: Initial confidence in treatment for low-back pain varies by type of care and other factors. Higher confidence may have some beneficial effect on the course of low-back pain in certain patients, but this effect may depend on the type of interaction between client and provider.