Effect of Expectations on Treatment Outcome for Lumbar Intervertebral Disc Herniation.
Effect of Expectations on Treatment Outcome for Lumbar Intervertebral Disc Herniation.
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DOI：
10.1097/brs.0000000000001333
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发表时间：
2016-05
期刊：
影响因子：
3
通讯作者：
Weinstein JN
中科院分区：
文献类型：
--
作者：
Lurie JD;Henderson ER;McDonough CM;Berven SH;Scherer EA;Tosteson TD;Tosteson AN;Hu SS;Weinstein JN
随机和非随机前瞻性队列的二次分析。研究患者治疗期望对腰椎间盘突出症患者治疗结果的影响。患者对治疗效果的期望可能与临床结果有重要关系。脊柱患者结果研究试验的分组和重新分析，这是一项随机试验和综合队列研究，在2000年3月至2004年11月期间从美国11个州的13个多学科脊柱诊所招募患者。总共有501名随机和744名(总计1244名)有神经根病和影像证实的腰椎间盘突出症的手术候选患者入选。初步研究比较了手术摘除和通常的非手术治疗；这一分组分析根据基线的治疗预期重新评估了结果。对手术和非手术治疗的症状和功能改善的期望以5分制(1=“没有机会(0%)”到5=“确定(100%)”)进行评估。采用纵向回归模型对结果进行评估，并根据接受的治疗进行分析。在1244名IDH运动参与者中，1168人提供了结果和基线预期的数据，并被纳入当前的分析：467人来自随机组，701人来自观察队列。对手术结果的低期望预示着无论治疗如何，结果都会更差。对非手术治疗结果的高期望值预示着更好的非手术治疗结果，但不影响手术结果。这些差异与手术和非手术治疗之间的结果差异具有相似的程度。治疗收益的高期望值与结果在临床上有显著的正相关。
Secondary analysis of randomized and non-randomized prospective cohorts. To examine the effect of patient treatment expectations on treatment outcomes for patients with intervertebral disc herniation. Patient expectations about treatment effectiveness may have important relationships with clinical outcomes. Sub-group and re-analysis of the Spine Patient Outcomes Research Trial, a randomized trial and comprehensive cohort study enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in 11 US states. Overall 501 randomized and 744 observational patients (1244 total) who were surgical candidates with radiculopathy and imaging confirmed lumbar intervertebral disc herniation were enrolled. The primary study compared surgical discectomy to usual non-operative care; this sub-group analysis reassessed outcomes based on treatment expectations at baseline. Expectations about symptomatic and functional improvement for both surgery and non-operative care were assessed on 5-point scales (1="No Chance (0%)" to 5="Certain (100%)"). Outcomes were assessed using longitudinal regression models analyzed by treatment received. Among 1244 IDH SPORT participants, 1168 provided data on both outcomes and baseline expectations and were included in the current analysis: 467 from the randomized and 701 from the observational cohort. Low expectations of outcomes with surgery predicted poorer outcome regardless of treatment. High expectations of outcomes with non-operative care predicted better non-operative outcomes but did not affect surgical results. These differences were of similar magnitude to the difference in outcomes between surgery and non-operative care. High expectations of treatment benefit had clinically significant positive associations with outcomes.