A critical literature review on the effect of treatment expectancy, preference and general optimism on outcome in physiotherapy for chronic low back pain

Background:

Chronic low back pain (cLBP) is a common disorder with psychosocial dimensions that are associated with significant costs to individuals and society. Patients with cLBP demonstrate treatment preferences and expectancies, and are often dissatisfied with the treatment decision-making process that occurs in busy physiotherapy outpatient departments.

Aims:

This review aims to evaluate the evidence for the use of treatment expectancy and treatment preference measures in treatment planning for the physiotherapy management of cLBP.

Methods:

Electronic literature searches were conducted on MEDLINE, CINAHL, Embase, PschoINFO, AMED, Cochrane database of systematic reviews, the Cochrane Library and the NHS Centre for Reviews and Dissemination. Studies were selected using pre-defined criteria. The Critical Appraisal Skills Programme (CASP) tool was used to assess studies methodological quality.

Results:

The search strategy identified 6 articles for inclusion in this review. Interventions employed in the studies included: acupuncture, cognitive behavioural therapy (CBT), exercise, and massage.

Conclusions:

Higher treatment expectancy and treatment preference are associated with improved outcome following physiotherapy for cLBP. General optimism regarding treatment outcome is not associated with improved outcome. Futures studies should agree on a definition for treatment expectancy and design a valid and reliable tool for outcome measurement of treatment expectancy and preference for use in clinical practice with cLBP patients.