Abstract
Background: Low back pain is costly and disabling. Prognostic factor evidence can help healthcare providers and patients understand likely prognosis, inform the development of prediction models to identify subgroups, and may inform new treatment strategies. Recent studies have suggested that people who have poor expectations for recovery experience more back pain disability, but study results have differed. Objectives: To synthesise evidence on the association between recovery expectations and disability outcomes in adults with low back pain, and explore sources of heterogeneity. Search methods: The search strategy included broad and focused electronic searches of MEDLINE, Embase, CINAHL, and PsycINFO to 12 March 2019, reference list searches of relevant reviews and included studies, and citation searches of relevant expectation measurement tools. Selection criteria: We included low back pain prognosis studies from any setting assessing general, self-efficacy, and treatment expectations (measured dichotomously and continuously on a 0 - 10 scale), and their association with work participation, clinically important recovery, functional limitations, or pain intensity outcomes at short (3 months), medium (6 months), long (12 months), and very long (> 16 months) follow-up. Data collection and analysis: We extracted study characteristics and all reported estimates of unadjusted and adjusted associations between expectations and related outcomes. Two review authors independently assessed risks of bias using the Quality in Prognosis Studies (QUIPS) tool. We conducted narrative syntheses and meta-analyses when appropriate unadjusted or adjusted estimates were available. Two review authors independently graded and reported the overall quality of evidence. Main results: We screened 4635 unique citations to include 60 studies (30,530 participants). Thirty-five studies were conducted in Europe, 21 in North America, and four in Australia. Study populations were mostly chronic (37%), from healthcare (62%) or occupational settings (26%). General expectation was the most common type of recovery expectation measured (70%); 16 studies measured more than one type of expectation. Usable data for syntheses were available for 52 studies (87% of studies; 28,885 participants). We found moderate-quality evidence that positive recovery expectations are strongly associated with better work participation (narrative synthesis: 21 studies; meta-analysis: 12 studies, 4777 participants: odds ratio (OR) 2.43, 95% confidence interval (CI) 1.64 to 3.62), and low-quality evidence for clinically important recovery outcomes (narrative synthesis: 12 studies; meta-analysis: 5 studies, 1820 participants: OR 1.89, 95% CI 1.49 to 2.41), both at follow-up times closest to 12 months, using adjusted data. The association of recovery expectations with other outcomes of interest, including functional limitations (narrative synthesis: 10 studies; meta-analysis: 3 studies, 1435 participants: OR 1.40, 95% CI 0.85 to 2.31) and pain intensity (narrative synthesis: 9 studies; meta-analysis: 3 studies, 1555 participants: OR 1.15, 95% CI 1.08 to 1.23) outcomes at follow-up times closest to 12 months using adjusted data, is less certain, achieving very low- and low-quality evidence, respectively. No studies reported statistically significant or clinically important negative associations between recovery expectations and any low back pain outcome. Authors' conclusions: We found that individual recovery expectations are probably strongly associated with future work participation (moderate-quality evidence) and may be associated with clinically important recovery outcomes (low-quality evidence). The association of recovery expectations with other outcomes of interest is less certain. Our findings suggest that recovery expectations should be considered in future studies, to improve prognosis and management of low back pain.
| Original language | English |
|---|---|
| Article number | CD011284 |
| Journal | Cochrane Database of Systematic Reviews |
| Volume | 2019 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - Nov 25 2019 |
Bibliographical note
Funding Information:Funding Source: Agency for Health Care Policy and Research; The National Institute for Dental Research; National Health Research and Development Program of Canada
Funding Information:
Funding Source: Research Council of Norway; the Swedish Chiropractic Association
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Funding Source: The Goteborg Medical Society; The Asker Foundation; The Delegation for Social Research within the Swedish Ministry for Health and Social Affairs
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TP has no known conflicts of interest related to the topic of this review. She is employed full time by the Royal Holloway University of London and has received grants from Arthritis Research UK, and NIHR.
Funding Information:
Funding Source: Danish Chiropractors’ Foundation and Macroeconomic Policy Institute Almene Fond grant
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The authors thank Leah Boulos (Maritime SPOR SUPPORT Unit) and Rachel Couban (formerly with the Cochrane Back Review Group) for their assistance with the search strategies; we thank Andrea Smith, Michelle Tougas, and Jenny Cartwright (formerly with the Department of Community Health & Epidemiology, Dalhousie University) for contributions to early review planning, study screening and data extraction; we thank Emma Wilson-Pease for her assistance with study screening and data extraction; and we appreciate Jenna Ellis's assistance with summary forest plots. We thank the Cochrane Back and Neck, and Cochrane Prognosis Methods Group peer reviewers and editors for their comments and helpful suggestions, including: Chris Maher, Professor, University of Sydney and Director, Institute for Musculoskeletal Health, Sydney; Tim Carey MD MPH University of North Carolina at Chapel Hill; Dr Marialena Trivella, Centre for Statistics in Medicine, University of Oxford; and Janet Gunderson.
Funding Information:
Funding Source: The Swiss National Science Foundation; HES-SO
Funding Information:
Funding Source: State Medical Society of Wisconsin Foundation; Pfizer, Inc.; Mercury Marine; Roche Pharmaceuticals; Deere & Company (Horicon); Monsanto Fund; Quad Graphics; Pharmacia
Funding Information:
JAH has no known conflicts of interest related to the topic of this review. She is a Co-Convenor of the Cochrane Prognosis Methods Group and Advisory Board Member of Cochrane Back and Neck, however was not involved in editorial decisions involving this review. She has received peer-reviewed funding from the Canadian Institutes of Health Research, the Nova Scotia Health Research Foundation, and Cochrane. She previously held a Canadian Chiropractic Research Foundation/Dalhousie University Research Professorship in Epidemiology.
Funding Information:
Funding Source: Comité d’attribution de fonds internes de recherche Research Fund of the University of Montreal
Funding Information:
Funding Source: Australian General Practice Evaluation Programme; The Australian Association of Musculoskeletal Medicine; The Musculoskeletal Research Foundation of Australia
Publisher Copyright:
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ASJC Scopus Subject Areas
- Pharmacology (medical)