ARE PATIENT EXPECTATIONS ASSOCIATED WITH TREATMENT OUTCOMES IN INDIVIDUALS WITH CHRONIC LOW BACK PAIN? A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS

Aim The importance of patient expectations (PEs) on treatment outcomes is poorly understood in clinical practice. The aim of this review is to investigate the evidence behind association between pre-treatment PEs and treatment outcomes such as pain intensity (PI), level of function (LF) and health-related quality of life (HRQOL) among individuals with chronic low back pain (CLBP) Methods A systematic search was conducted for randomised controlled trials published between 1946 and May 2019 across major databases using the key MeSH terminologies. The association between PEs and PI, LF and HRQOL were extracted and categorized into positive, negative or no association for analysing the data. A descriptive synthesis was conducted and the association between PEs and PI, LF and HRQOL were reported. Results Among the total of 7 trials, 2 trials demonstrated a positive association between PEs and PI in short (≤ 6 weeks) and long term (> 6 months), while another 2 trials demonstrated no association at medium term (> 6 weeks - ≤ 6 months). About 4 trials demonstrated a positive significant association between PEs and LF, 2 at medium and 2 at long terms. The only available trial demonstrated no association between PEs and HRQOL at medium term. Conclusion Positive PEs as measured at the start of treatment is associated with PI. Inconclusive evidence exists on the association between PEs and LF. Limited studies show no evidence of association between PEs and HRQOL. Further studies with valid tools to measure PE are warranted among individuals with CLBP.