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Surprise: Patients Who Expect Favorable Result Are Substantially More Likely to Achieve One

Patient expectations and beliefs may play a major role in determining treatment outcomes, according to a new study. In a trial comparing physical treatments for chronic low back pain, patients with high expectations of treatment benefit were significantly more likely to have favorable outcomes than those with low expectations. “This study showed that patient expectation for benefit from a physical treatment correlates significantly with improved clinical outcome, after adjusting for sociodemographic, health status, and physical factors,” according to Donna A. Kalauokalani, MD, and colleagues. “Regardless of the treatment received, the effect of treatment depended on the subject’s relative strength of expectation of that treatment.” (See Kalauokalani et al., 2000.) Kalauokalani presented the findings at the Fourth International Forum for Primary Care Research on Low Back Pain in Eilat, Israel. The study appears to provide a strong rationale for shared decisionmaking, in which an informed patient makes treatment choices based on his or her goals, treatment expectations, and tolerance for risk. The results also have significant implications regarding the design of clinical trials of back pain treatments. Could some of the outcomes attributed to specific treatments in clinical trials relate more to treatment expectations than to inherent superiority of the therapies under study? There is no clear answer to this question, because most randomized trials to date have not monitored patient expectations of treatment benefit.