Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain
Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain
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DOI：
10.1080/24740527.2017.1384297
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发表时间：
2017-01-01
影响因子：
2.4
通讯作者：
Macfarlane, Gary John
中科院分区：
文献类型：
--
作者：
Beasley, Marcus John;Ferguson-Jones, Elizabeth Alice;Macfarlane, Gary John
背景：患者对治疗的信念和态度会影响治疗反应。在非盲法试验中，这可能会影响结果。目的：这项分析的目的是检验疼痛治疗试验中治疗偏好、预期和结果之间的关系。方法：在一项包含四种慢性广泛性疼痛治疗方法的随机试验(ISRCTN67013851)中，参与者被问及他们更喜欢哪种方法，以及他们对每种方法的改善预期。在治疗后的三个时间点，参与者报告积极健康结果的比例在与他们的偏好匹配或不匹配的参与者之间以及在有改善预期和没有改善预期的参与者之间进行比较。根据与偏好和期望相关的基线特征计算调整后的优势比。结果：442名参与者被招募到试验中(695%为女性)。与不匹配的参与者相比，符合他们偏好的参与者报告阳性结果的比例在治疗结束时为33.3%比34.4%(调整后的优势比[AOR]=0.80，95%可信区间[CI]，0.44-1.46)，在3个月时为34.4%比29.0%(AOR=1.23，95%CI，0.67-2.26)，在2年时为34.8%比30.3%(AOR=131，95%CI，0.702.46)。治疗结束时，预期改善的患者与未预期改善的患者相比，报告阳性结果的比例为36.6%比15.0%(AOR=2.03，95%CI，1.07~3.85)，3个月时34.1%比13.2%(AOR=2.31，95%CI，1.22~4.38)，2年时32.8%比19.1%(AOR=1.16，95%CI，0.67~2.36)。但Expect做到了。这些结果可能会为未来的管理方法提供信息，评估治疗的研究人员应该考虑这种预期效应。
Background: Patients' beliefs and attitudes toward a treatment can affect treatment response. In unblinded trials this can affect outcomes.Aims: The aim of this analysis was to examine the association between treatment preference and expectation and outcome in a trial of pain treatments.Methods: In a randomized trial (ISRCTN67013851) of four treatments for chronic widespread pain, participants were asked which they would prefer and what improvement they expect from each. The proportion of participants reporting positive health outcomes at three time points after treatment were compared between those matched or unmatched with their preference and between those with and without expectation for improvement. Odds ratios were calculated adjusted for baseline characteristics associated with preference and expectation.Results: Four hundred forty-two participants were recruited to the trial (695% female). The proportion reporting positive outcomes among participants matched to their preference compared to those unmatched was 33.3% vs. 34.4% at the end of treatment (adjusted odds ratio [aOR] = 0.80, 95% confidence interval [CI], 0.44-1.46), 34.4% vs. 29.0% at 3 months (aOR = 1.23, 95% CI, 0.67-2.26), and 34.8% vs. 30.3% at 2 years (aOR = 131, 95% CI, 0.702.46). The proportion of participants reporting positive outcomes among those expecting improvement compared to those not expecting improvement was 36.6% vs. 15.0% at the end of treatment (aOR = 2.03, 95% CI, 1.07-3.85), 34.1% vs. 13.2% at 3 months (aOR = 2.31, 95% CI, 1.22-4.38), and 32.8% vs. 19.1% at 2 years (aOR = 1.16, 95% CI, 0.67-2.36).Conclusions: Treatment preference had no dear effect on outcomes, but expectation did. These results could inform future approaches to management, and researchers assessing treatments should take into account this expectation effect.