The influence of clinical equipoise and patient preferences on outcomes of conservative manual interventions for spinal pain: an experimental study
Authors Bishop MD, Bialosky JE, Penza CW, Beneciuk JM, Alappattu MJ
Received 22 December 2016
Accepted for publication 21 February 2017
Published 26 April 2017 Volume 2017:10 Pages 965—972
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Michael Schatman
Mark D Bishop,1,2 Joel E Bialosky,1–3 Charles W Penza,1,2 Jason M Beneciuk,1,3 Meryl J Alappattu1,2
1Department of Physical Therapy, University of Florida, 2Center for Pain Research and Behavioral Health, 3Brooks-PHHP Research Collaboration, Gainesville, FL, USA
Background: Expected pain relief from treatment is associated with positive clinical outcomes in patients with musculoskeletal pain. Less studied is the influence on outcomes related to the preference of patients and providers for a specific treatment.
Objectives: We sought to determine how provider and patient preferences for a manual therapy intervention influenced outcomes in individuals with acutely induced low back pain (LBP).
Participants and methods: Pain-free participants were randomly assigned to one of two manual therapies (joint biased [JB] or constant touch [CT]) 48 hours after completing an exercise protocol to induce LBP. Expectations for pain relief and preferences for treatment were collected at baseline, prior to randomization. Pain relief was assessed using a 100 mm visual analog scale. All study procedures were conducted in a private testing laboratory at the University of Florida campus.
Results: Sixty participants were included in this study. After controlling for preintervention pain intensity, the multivariate model included only preintervention pain (B=0.12, p=0.07) and provider preference (B=3.05, p<0.0001) and explained 35.8% of the variance in postintervention pain. When determining whether a participant met his or her expected pain relief, receiving an intervention from a provider with a strong preference for that intervention increased the odds of meeting a participant’s expected pain relief 68.3 times (p=0.013) compared to receiving any intervention from a provider with no preference. Receiving JB intervention from any provider increased the odds of meeting expected relief 29.7 times (p=0.023). The effect of a participant receiving an intervention they preferred was retained in the model but did not meet the criteria for a significant contribution.
Conclusion: Our primary findings were that participant and provider preferences for treatment positively influence pain outcomes in individuals with acutely induced LBP, and joint-biased interventions resulted in a greater chance of meeting participants’ expected outcomes. This is contrary to our hypothesis that the interaction of receiving an intervention for which a participant had a preference would result in the best outcome.
Keywords: equipoise, expectations, manual therapy, acute pain
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