Treatment Outcome Expectations Research Articles

Treatment of migraine: a review of disease burden and an update on the therapeutic landscape for pharmacists

Given the key role of pharmacists as a healthcare resource for patients seeking treatment of headache associated with migraine, this review highlights the burden of migraine, recent advances in preventive migraine therapies, and key takeaways from the most recent migraine management consensus statement. For at least two decades, it has been understood that correct diagnosis of migraine is key to its effective management. Migraine attacks should be treated promptly with acute medications, with preventive treatment for patients with regular, frequent, and/or disabling migraine attacks. Nonetheless, most patients with migraine are still not correctly diagnosed, and do not receive appropriate therapy for acute or preventive treatment of their disease. In addition, patients may be refractory to or unable to tolerate traditional oral preventive treatments, leading to underutilization of preventive treatment and subsequent reliance on acute treatment. Overuse of acute medications is associated with increased risk of progression from episodic to chronic migraine and development of medication overuse headache; therefore, pharmacists should counsel patients receiving over-the-counter or prescription acute migraine medications on when to seek options for preventive treatment to help avoid medication overuse. Pharmacists are well-positioned to identify those patients who would benefit from physician referral for further assessment and treatment with preventive therapy. They also have an important role in educating patients on the benefits of preventive medications, and realistic expectations of treatment outcomes.

Self-Esteem in 12-Step Recovery; Theoretical History, Evidence, and Implications for Future Research

ABSTRACT Recovery from substance use disorder is a complex process whereby an interplay of personal strengths, interpersonal relationships, and contextual factors come together to make recovery possible. New and emerging theories and definitions of recovery are prompting recovery-informed research that places a premium on operationalizing known features of the recovery process into new instruments and methods. We hypothesize that self-esteem plays a central role in the recovery process such that it may one day serve as a benchmark of recovery growth and progress. In this article, we use a secondary analysis of an existing dataset to examine self-esteem as a central intrapersonal variable in a sample of people in recovery from substance use disorder (N = 113) and identify correlates with psychological and personality factors associated with recovery. Our findings provide additional evidence that self-esteem, and correlates of self-esteem, may represent a bundle of intrapersonal psychosocial variables that should be considered as essential constructs within recovery-related research, therapeutic technique, and treatment outcome expectancies.

Quantification of Severity of Unilateral Coronal Synostosis.

Objectives:Severity of unilateral coronal synostosis (UCS) can vary. Quantification is important for treatment, expectations of treatment and natural outcome, and education of the patient and parents.Design:Retrospective study.Setting:Primary craniofacial center.Patients, Participants:Twenty-three preoperative patients with unilateral coronal craniosynostosis (age < 2 years).Intervention:Utrecht Cranial Shape Quantifier (UCSQ) was used to quantify severity using the variables: asymmetry ratio of frontal peak and ratio of frontal peak gradient.Main Outcome Measures(s):The UCSQ variables were combined and related to visual score using Pearson correlation coefficient; UCSQ and visual score were additionally compared to Di Rocco classification by one-way analysis of variance or Kruskal-Wallis test. All measurements were made on computed tomography scans.Results:Good correlation between UCSQ and visual score was found (r = 0.67). No statistically significant differences were found between group means of UCSQ in the 3 categories of Di Rocco classification (F 2,20 = 0.047; P > .05). Kruskal-Wallis test showed no significant differences between group means of visual score in the 3 categories of Di Rocco classification (Kruskal-Wallis H (2) = 0.871; P > .05).Conclusions:Using UCSQ, we can quantify UCS according to severity using characteristics, it outperforms traditional methods and captures the whole skull shape. In future research, we can apply UCSQ to 3D-photogrammetry due to the utilization of external landmarks.

Orthodontists and lay people rate masculine soft tissue profiles similarly but feminine soft tissue profiles differently

<p>Objective: An esthetic facial soft tissue profile is an important objective of contemporary orthodontics. The extent to which clinicians and the public agree on profiles that are esthetically acceptable versus profiles recommended for treatment is unclear. Thus, this work examined the profile considered esthetic by laypeople and general dental practitioners compared to orthodontists.<br /> Method and materials: An Israeli balanced male-female group comprising 284 participants (orthodontists [n&nbsp;=&nbsp;86], general dental practitioners [n&nbsp;=&nbsp;64], laypeople [n&nbsp;=&nbsp;134]) rated the attractiveness of five standardized masculine and feminine profiles presented in standardized silhouettes ranging from concave to convex.<br /> Results: Laypeople see no esthetic difference between masculine and feminine profiles, and prefer moderately concave over moderately convex and severely concave over severely convex profiles. While all raters preferred the straight silhouettes, orthodontists rated them significantly higher than general dental practitioners (P&nbsp;&lt;&nbsp;.0001) or laypeople (P&nbsp;&lt;&nbsp;.020). Similar to the general population, orthodontists gave higher ratings to concave profiles for masculine profiles, but significantly lower ratings for feminine profiles. The severely convex male profile was the least attractive to clinicians and laypeople. There was a significant difference in the attractiveness of the female profile between practitioners (P&nbsp;&lt;&nbsp;.001 and P&nbsp;&lt;&nbsp;.02 for general dental practitioners and orthodontists, respectively) and laypeople.<br /> Conclusions: The findings suggest that orthodontic training and clinical adherence to strict beauty norms results in more critical judgment of female attractiveness, which may affect orthodontic treatment. They indicate trends that reflect changes in recent decades in the public perception of facial beauty, which may affect patient expectations of treatment outcomes.</p>.

Pre-consultation information about one’s physician can affect trust and treatment outcome expectations

ObjectiveInformation about physicians’ skills is increasingly available on the internet and consulted by patients. The impact of such information on patient expectations is largely unknown. The aim of the present study was to investigate whether information about the competence and empathic skills of a physician may impact pre-consultation trust and treatment outcome expectations in mild and severe medical conditions. MethodsIn this experimental web-based study, participants (n = 237) read vignettes describing competence and empathic skills (low versus high) of a fictive physician who would surgically remove a mole or melanoma (low versus high severity) following a 2 × 2 × 2 between-subjects design. Participants rated trust in the physician and treatment outcome expectations. ResultsHigh competence and empathy raised trust in the physician, regardless of condition severity. High competence and high empathy both also increased expected surgery success, while only high competence reduced expected side effects. ConclusionPre-consultation information highlighting a physician’s competence and/or empathy may lead to higher trust in that physician, higher expected surgery success, and lower expected side effects. Practice ImplicationsPhysicians and hospital staff should be aware of the effects of written information available and might, for example, provide profiles on hospital websites emphasizing healthcare providers’ competence and empathy.

Professional and Personal Development After Psychoanalytic Training: Interviews with Early Career Analysts.

After analytic training, graduates position their newly acquired identity as "psychoanalyst" in the context of their broader career, contemplating whether to start new analytic cases, adapting their new knowledge base to psychotherapy practice, and deciding how to focus their professional and personal interests going forward. Using questionnaires and interviews, the Columbia Postgraduate Analytic Practice Study (CPAPS) has prospectively tracked the career trajectory of 69 of 76 graduates (91%) from the Columbia University Center for Psychoanalytic Training and Research since 2003. In this paper grounded theory is used to identify developmental themes in interviews with analysts who have been followed for at least ten years. Recent graduates are negotiating the following challenges: developing a sense of competence, navigating relationships with colleagues and former supervisors as situations change and roles shift, transitioning into becoming mentors, and balancing the competing responsibilities of professional and personal life. Disillusionment about aspects of training, analytic practice, analysis as a treatment, institute politics, and the field in general emerges as a stark reality, despite a high level of career satisfaction. Educational recommendations include making career development opportunities available and providing a realistic view of both practice realities and expectations of analytic treatment outcome.

Expectations of breast-conserving therapy: a qualitative study

BackgroundEarly-stage breast cancer is often treated with breast-conserving therapy (BCT), including lumpectomy with radiation therapy. Patients’ expectations of BCT remain largely unknown. Expectations affect perceptions of treatment-related experiences and health-related quality of life (HR-QOL) outcomes. Our primary aim was to describe expectations of BCT among patients with early breast cancer through qualitative methods. Our secondary aim was to inform preoperative patient education and improve the patient experience through knowledge.MethodsWe used a grounded-theory approach to investigate a convenience sample of 22 women with stage I and II breast cancer who were treated with BCT at a single hospital in New York City between May and August 2016. Semi-structured interviews were conducted in person and by telephone. Open-ended questions covered participants’ expectations of treatment experiences and outcomes. Data was analyzed in a line-by-line approach to identify emergent themes related to patient expectations. Interviews continued until no new themes emerged.ResultsAnalysis of data identified the following themes related to patient expectations of BCT: experience of cancer care, recovery, appearance, and HR-QOL. Despite preoperative informed consent and teaching, participants expressed few expectations preoperatively, owing to a lack of knowledge about the process of care. Lack of expectations preoperatively was compensated with available care and resources postoperatively.ConclusionsPatients in our sample had a surprisingly limited understanding of what to expect during treatment with BCT. Despite available information and preoperative teaching, patients have a clear knowledge gap regarding BCT. These findings suggest patients often undergo cancer treatment with trust rather than complete understanding of the process. This data may be used to enhance preoperative discussions aimed at preparing patients for surgery and treatment.

Characterizing the Use of Expectations in Orthopedic Surgery Research: A Scoping Review.

ObjectiveOrthopedic literature on expectations is limited by lack of uniformity in how expectations are defined, conceptualized, and measured. Within this scoping review, we present a conceptual framework for understanding the construct of expectations and its derivatives (ie, expectation, expectancy, expectancies, etc) in studies of elective surgical orthopedic procedures. We also utilize this framework to map the current orthopedic surgery literature on expectations, highlighting its strengths, weaknesses, and gaps in its knowledge base.MethodsWe included articles that mentioned both expectations and one or more of 10 selected surgeries in their title or abstract. We focused on representative elective orthopedic surgeries that covered the body's major regions. We operationalized each study's individual expectation items into one of the expectation concept types within the presented conceptual model. We also extracted the name and type of expectations measurement tool used, whose expectations were measured, and descriptive information (eg, surgery type, publication date, country of origin, and study type).ResultsNinety studies were included, with 70% published after 2008. A total of 64% investigated total knee and total hip arthroplasty, whereas 90% of studies investigated the expectations of patients, 5.6% investigated the expectations of physicians, and 4.4% investigated both. Of all studies, 72% utilized either study‐specific instruments with close‐ended, Likert‐type response formats or modifications of existing expectations questionnaires. Most studies focused on desirable, nontimeline‐related, treatment outcome expectations. Many studies aggregated multiple expectation results into a single score.ConclusionAdopting the standardized framework for expectations presented in this study will foster clearer communication and permit researchers to aggregate results across studies.

The Relationship Between Client Regulatory Focus and Treatment Use Intentions, Attitudes, Credibility Beliefs, and Outcome Expectations for Psychotherapy

Client variables in psychotherapy have been shown to play an important role in psychotherapy, explaining a significant amount of variance in treatment engagement, the therapeutic alliance, and psychotherapy outcomes; however, little is known about how the client variables develop. Specifically, there may be internal characteristics of the client that underlie several client attitudinal variables that play a role in psychotherapy. The purpose of this study was to test one particular client internal characteristic (regulatory focus) as a predictor of the psychotherapy use intentions, attitudes, credibility beliefs, and outcome expectations that clients hold. Participants from a nation-wide sample of adult clients (N = 663) and a sample of college students (N = 192) completed measures of regulatory focus, treatment use intentions, attitudes toward psychotherapy, credibility beliefs, and outcome expectations. Taken together, participants’ promotion-focus and prevention-focus scores significantly predicted treatment use intentions, attitudes, credibility beliefs, and outcome expectations. Specifically, across both samples a greater promotion-focus was significantly associated with more positive attitudes, credibility beliefs, and expectations. In contrast, a greater prevention-focus was significantly associated with more negative attitudes and not significantly related to credibility beliefs for psychotherapy. These results suggest that researchers and clinicians may want to focus on increasing promotion-focused goals and attitudes in clients in order to increase psychotherapy treatment-seeking and engagement.

Psihometrijske karakteristike Skale očekivanja promene u vezi sa psihološkim problemom (PPCES)

The Psychological Problem Change Expectancy Scale (PPCES) is an instrument designed to assess the client's outcome expectations of a psychological treatment. It is based on the Anxiety Change Expectancy Scale (ACES; Dozois & Westra, 2005). The expectancies regarding the psychological change as a treatment outcome expectation are conceptualized as a system of client's prognostic beliefs about the consequences of participation in some kind of psychological treatment, i.e. the client's expectation of improvement of his/her state as a consequence of participation in a psychological treatment. This paper was aimed at evaluating the basic metric characteristics of the ACES adaptation. The adaptationc onsisted of translating the items into Serbian language and changing the content in order to generally imply to the psychological problem which had been the reason for a person to seek a professional help. The research incorporated two separate studies. In Study 1, conducted on the sample of 171 clients beginning the psychological treatment, the internal consistency and the latent structure of the scale were investigated by exploratory factor analysis (EFA). In Study 2, conducted on the sample of 240 students participating in ananalogue study, the construct validity was additionally checked by confirmatory factor analysis (CFA). The results of the EFA suggested a high heterogeneity of the scale, while the CFA, due to the impossibility of confirming the original model, suggested a potential shortening of the scale from the initial twenty to eleven items, organized into the bifactor model. The items were organized in two specific factors - change optimism and change pessimism, together with the general factor - treatment outcome expectations. Concurrent validity was confirmed by adequate correlations with the measures of dispositional optimism, self-efficacy and the measures of subjective well-being. It can be concluded that the PPCES scale is a reliable and valid instrument for assessing the expectations of treatment outcomes, but it is more structurally homogeneous in the form of 11 items compared to the initial structure. Because of the specificity of the samples from both studies, future research should additionaly check the structural validity of the PPCES, especially within the clinical population and more homogeneous psychotherapy samples.

Effect of patients' expectations on clinical response to fampridine treatment.

Patient expectation of treatment outcome is one of the primary mechanisms underlying the placebo effect. In multiple sclerosis trials with symptomatic treatments, a robust placebo effect is observed, which might be related to patient expectations. The aim of this study was to evaluate whether patient expectations regarding fampridine treatment influence the clinical response after 4weeks and 6months of treatment. We designed and carried out a prospective study from June 2015 to August 2017. Before treatment, patients completed a questionnaire including a scale evaluating their expectations regarding the treatment. The effect of baseline positive expectancy on the response status after 4weeks and 6months of treatment was analyzed through univariable and, when applicable, multivariable analysis. A total of 47 consecutive patients were included in the study. At week 4, 37 (78.7%) patients were classified as responders; a one-point increase in the positive expectancy questionnaire was significantly associated with a fourfold increase in the likelihood of being a responder [OR = 4.020 (95% CI 1.082-14.933); p = 0.038]. At 6months, 43 patients completed follow-up. The number of responders decreased to 28; at this point, positive expectancy at baseline was no longer associated with response status. Baseline positive expectancy regarding fampridine was determinant of the clinical response after 4weeks of treatment. However, in the long term, fampridine efficacy was not dependent on expectations prior to treatment.

Treatment expectancy and working alliance in pharmacotherapy as predictors of outcomes in complicated grief.

Nonspecific factors, such as treatment outcome expectancy and working alliance, can influence treatment outcome. No studies to date have examined the role of expectancy and alliance on pharmacotherapy outcomes in individuals with complicated grief (CG). This secondary analysis of a larger randomized, control trial (RCT) examined the relationship between pharmacotherapy expectancy and alliance on treatment outcome in adults with CG who were participating in a multisite, double-blind, RCT examining the efficacy of citalopram and complicated grief treatment (CGT). Participants (n = 202) were randomized to one of four treatment conditions: citalopram (CIT), placebo (PBO), CGT + citalopram (CGT + CIT), or CGT + placebo (CGT + PBO). Pharmacotherapy outcome expectancy and working alliance were higher among individuals randomized to CGT + CIT and CGT + PBO compared with CIT or PBO without CGT. Pharmacotherapy outcome expectancy was higher at Week 2 among individuals who ultimately responded to treatment compared with those who did not and among those who remained in treatment compared with those who dropped out. In contrast, working alliance did not correlate with dropout or treatment outcomes in pharmacotherapy. Expectancy for medication was higher among individuals randomized to receive CGT. Clinicians should assess symptoms and expectancies in the first weeks of treatment because these could be early markers of drop out and treatment response. (PsycINFO Database Record

What the patient wants: Addressing patients' treatment targets in an integrative group psychotherapy programme.

Limited empirical attention has been devoted to individualized treatment objectives in intensive group therapy for personality dysfunction. This study investigated patients' ratings of distress associated with individual therapy goals - referred to as target object severity - in an intensive Evening Treatment Programme for patients with personality dysfunction. Change in target objective severity was examined in a sample of 81 patients who completed treatment in an intensive, integrative group therapy programme. Correlation and regression analyses were used to examine associations between change in target object severity and patients' pre-treatment diagnosis, symptom distress, and treatment outcome expectancy, and between change in target objective severity and patients' ratings of group therapy process (group climate, therapeutic alliance, group cohesion). The relationship between change in target objective severity and longer-range life satisfaction was also examined in a subsample of patients who rated life satisfaction at follow-up. While change in target objective severity was not significantly related to pre-treatment variables, significant associations were found with several aspects of group therapy process. Patients' experience of a highly engaged group climate was uniquely associated with improvement in target object severity. Such improvement was significantly related to longer-term life satisfaction after controlling for general symptom change. The working atmosphere in group therapy contributes to patients' progress regarding individual treatment targets, and such progress is an important factor in later satisfaction. Attention to individualized treatment targets deserves further clinical and research attention in the context of integrative group therapy for personality dysfunction. This study found that patients attending an integrative group treatment programme for personality dysfunction experienced significant improvement in severity of distress related to individual treatment objectives. Improvement in severity of distress related to individual treatment objectives was uniquely associated with patients' experience of an engaged, collaborative working atmosphere. Improvement in individual target objective severity was associated with patients' ratings of overall life satisfaction, rated an average of 9months following termination, after controlling for change in general symptom severity.

Patterns of Change in Collaboration Are Associated with Baseline Characteristics and Predict Outcome and Dropout Rates in Treatment of Multi-Problem Families. A Validation Study.

Objective: The present study validates the Multi-Problem Family (MPF)-Collaboration Scale), which measures the progress of goal directed collaboration of patients in the treatment of families with MPF and its relation to drop-out rates and treatment outcome.Method: Naturalistic study of symptom and competence-related changes in children of ages 4–18 and their caregivers.Setting: Integrative, structural outreach family therapy.Measures: The data of five different groups of goal directed collaboration (deteriorating collaboration, stable low collaboration, stable medium collaboration, stable high collaboration, improving collaboration) were analyzed in their relation to treatment expectation, individual therapeutic goals (ITG), family adversity index, severity of problems and global assessment of a caregiver’s functioning, child, and relational aspects.Results: From N = 810 families, 20% displayed stable high collaboration (n = 162) and 21% had a pattern of improving collaboration. The families with stable high or improving collaboration rates achieved significantly more progress throughout therapy in terms of treatment outcome expectancy (d = 0.96; r = 0.43), reaching ITG (d = 1.17; r = 0.50), family adversities (d = 0.55; r = 0.26), and severity of psychiatric symptoms (d = 0.31; r = 0.15). Furthermore, families with stable high or improving collaboration maintained longer treatments and had a bigger chance of finishing the therapy as planned. The odds of having a stable low or deteriorating collaboration throughout treatment were significantly higher for subjects who started treatment with low treatment expectation or high family-related adversities.Conclusion: The positive outcomes of homebased interventions for multi-problem families are closely related to “stable high” and an “improving” collaboration as measured with the MPF-Collaboration Scale. Patients who fall into these groups have a high treatment outcome expectancy and reduce psychological stress. For therapeutic interventions with multi-problem families it seems beneficial to maintain a stable high collaboration or help the collaboration, e.g., by fostering treatment expectation.

The relationship between clients' depression etiological beliefs and psychotherapy orientation preferences, expectations, and credibility beliefs.

The purpose of this study was to examine the relationship between clients' etiological beliefs for depression and treatment preferences, credibility beliefs, and outcome expectations for five different depression treatments-behavioral activation, cognitive therapy, interpersonal psychotherapy, pharmacotherapy, and psychodynamic psychotherapy. Adult psychotherapy clients (N = 98) were asked to complete an online survey that included the Reasons for Depression Questionnaire, a brief description of each of the five treatment options, and credibility, expectancy, and preference questions for each option. On average, the participating clients rated pharmacotherapy as significantly less credible, having a lower likelihood of success, and being less preferred than the four types of psychotherapy. In general, interpersonal psychotherapy was also rated more negatively than the other types of psychotherapy. However, these findings depended somewhat on whether the participating client was personally experiencing depression. Credibility beliefs, outcome expectations, and preferences for pharmacotherapy were positively associated with biological beliefs for depression; however, the other hypothesized relationships between etiological beliefs and treatment attitudes were not supported. Although the study is limited based on the specific sample and treatment descriptions that were used, the results may still have implications for psychotherapy research, training, and practice. (PsycINFO Database Record

Patients' Expectations Regarding Medical Treatment: A Critical Review of Concepts and Their Assessment.

Patients’ expectations in the context of medical treatment represent a growing area of research, with accumulating evidence suggesting their influence on health outcomes across a variety of medical conditions. However, the aggregation of evidence is complicated due to an inconsistent and disintegrated application of expectation constructs and the heterogeneity of assessment strategies. Therefore, based on current expectation concepts, this critical review provides an integrated model of patients’ expectations in medical treatment. Moreover, we review existing assessment tools in the context of the integrative model of expectations and provide recommendations for improving future assessment. The integrative model includes expectations regarding treatment and patients’ treatment-related behavior. Treatment and behavior outcome expectations can relate to aspects regarding benefits and side effects and can refer to internal (e.g., symptoms) and external outcomes (e.g., reactions of others). Furthermore, timeline, structural and process expectations are important aspects with respect to medical treatment. Additionally, generalized expectations such as generalized self-efficacy or optimism have to be considered. Several instruments assessing different aspects of expectations in medical treatment can be found in the literature. However, many were developed without conceptual standardization and psychometric evaluation. Moreover, they merely assess single aspects of expectations, thus impeding the integration of evidence regarding the differential aspects of expectations. As many instruments assess treatment-specific expectations, they are not comparable between different conditions. To generate a more comprehensive understanding of expectation effects in medical treatments, we recommend that future research should apply standardized, psychometrically evaluated measures, assessing multidimensional aspects of patients’ expectations that are applicable across various medical treatments. In the future, more research is needed on the interrelation of different expectation concepts as well as on factors influencing patients’ expectations of illness and treatment. Considering the importance of patients’ expectations for health outcomes across many medical conditions, an integrated understanding and assessment of such expectations might facilitate interventions aiming to optimize patients’ expectations in order to improve health outcomes.

Adherence to Prophylaxis in Adolescents and Young Adults with Severe Haemophilia: A Quantitative Study with Patients.

Introductionhaemophilia is an inherited bleeding disorder caused by a deficiency in one of the blood coagulation factors. For people affected by severe haemophilia, the deficiency can cause spontaneous internal bleeding. Most young people with severe haemophilia in the UK follow a preventative treatment regimen (prophylaxis) consisting of several intravenous injections of factor concentrate each week. There is good evidence that prophylaxis reduces bleeds whilst also improving quality of life. However, levels of adherence among young people with haemophilia reported in the existing literature vary widely and are predominately based on estimations made by healthcare professionals and parents. Additionally, drivers of (non)adherence among young people specifically have not been evidenced.Aimto assess self-reported adherence among young people with haemophilia, provide evidence of psychosocial predictors of adherence, and to establish the associations between non-adherence and number of bleeds and hospital visits.Methods91 participants were recruited during outpatient appointments in 13 haemophilia centres across England and Wales, and invited to complete a questionnaire assessing self-reported adherence (VERITAS-Pro), Haemophilia-related pain and impact of pain, Illness Perceptions, Beliefs about Medications, Self-efficacy, Outcome expectations, Positive and Negative Affect, and Social support. Number of hospital visits and bleeds during the previous six months were collected from medical files.ResultsOf 78 participants with complete data, just 18% had scores indicating non-adherence. Psychosocial predictors differed between intentional (skipping) and un-intentional (forgetting) non-adherence. Overall, however, better adherence was reported where participants perceived the need for prophylaxis was greater than their concern over taking it as well as having a positive expectancy of its effectiveness, good social support and a stronger emotional reaction to having haemophilia.ConclusionThe findings indicate that adherence is generally good, and that assessing illness and treatment beliefs, social support and outcome expectations may play a valuable role in identifying which individuals are at risk of non-adherence. Interventions aimed at improving adherence should particularly consider improving social support, reducing patients’ concerns about prophylaxis, increasing their belief in the necessity of prophylaxis, and increasing positive outcome expectations.

Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables

Background and aimsIdentification of psychosocial variables may influence treatment outcome. The objective of this study was to prospectively examine whether psychosocial variables, in addition to clinical variables (pain, functioning, general health, previous neck pain, comorbidity), are predictive factors for treatment outcome (i.e. global perceived effect, functioning and pain) in patients with sub-acute and chronic non-specific neck pain undergoing physical therapy or manual therapy. Psychosocial factors included treatment outcome expectancy and treatment credibility, health locus of control, and fear avoidance beliefs. MethodsThis study reports a secondary analysis of a primary care-based pragmatic randomized controlled trial. Potential predictors were measured at baseline and outcomes, in 181 patients, at 7 weeks and 26 weeks. ResultsHierarchical logistic regression models showed that treatment outcome expectancy predicted outcome success, in addition to clinical and demographic variables. Expectancy explained additional variance, ranging from 6% (pain) to 17% (functioning) at 7 weeks, and 8% (pain) to 16% (functioning) at 26 weeks.Locus of control and fear avoidance beliefs did not add significantly to predicting outcome. ConclusionsBased on the results of this study we conclude that outcome expectancy, in patients with non-specific sub-acute and chronic neck pain, has additional predictive value for treatment success above and beyond clinical and demographic variables. ImplicationsPsychological processes, health perceptions and how these factors relate to clinical variables may be important for treatment decision making regarding therapeutic options for individual patients.

Mental health treatment outcome expectancies in Burundi.

Best practices in global mental health stress the importance of understanding local values and beliefs. Research demonstrates that expectancies about the effectiveness of a given treatment significantly predicts outcome, beyond the treatment effect itself. To help inform the development of mental health interventions in Burundi, we studied expectancies about the effectiveness of four treatments: spiritual healing, traditional healing, medication, and selected evidence-based psychosocial treatments widely used in the US. Treatment expectancies were assessed for each of three key syndromes identified by previous research: akabonge (a set of depression-like symptoms), guhahamuka (a set of trauma-related symptoms), and ibisigo (a set of psychosis-like symptoms) . In individual interviews or written surveys in French or Kirundi with patients ( N = 198) awaiting treatment at the clinic, we described each disorder and the treatments in everyday language, asking standard efficacy expectations questions about each ("Would it work?" "Why or why not?"). Findings indicated uniformly high expectancies about the efficacy of spiritual treatment, relatively high expectancies for western evidence-based treatments (especially cognitive behavior therapy [CBT] for depression-like symptoms), lower expectancies for medicine, and especially low expectancies for traditional healing (except for traditional healing for psychosis-like symptoms). There were significant effects of gender but not of education level. Qualitative analyses of explanations provide insight into the basis of people's beliefs, their explanations about why a given treatment would or would not work varied by type of disorder, and reflected beliefs about underlying causes. Implications for program development and future research are discussed.

Patient Pre-Treatment Expectations Do Not Predict Cocaine Use Outcomes: Data From Four Clinical Trials

ABSTRACTBackground: There are very few data regarding the extent to which patients' initial expectations regarding treatment are associated with substance use treatment outcomes. Objective: This study sought to determine how patients' treatment expectations were associated with treatment outcomes. Methods: This study explored patient pre-treatment expectations and substance use treatment outcomes for 387 individuals participating in treatment for cocaine use within the United States (68.2% male, mean age 36 years old, 54.8% Caucasian). Results: Participants' expectations regarding abstinence were not strongly associated with post-treatment or follow-up cocaine use outcome measures. There was a significant association between the expected timeframe of receiving a positive treatment effect (i.e., outcome efficiency expectations) and days of cocaine use at the 1-month follow-up point (F = 3.45, p =.009). Post-hoc comparisons revealed that participants that expected positive effects of treatment within 0–1 week reported fewer days of cocaine use than those that expected results in 1–2 months. Also, those that expected positive effects of treatment in 1–2 months reported more cocaine use than those who expected positive results within two weeks to one month. Further, there was a significant effect of outcome efficiency expectations on a proxy measure of achieving a good treatment outcome at the three-month follow-up point (F = 11.13, p =.025). Conclusions/Importance: Results suggest that treatment outcomes are not associated with patients' treatment outcome expectations, but that some outcomes are associated with treatment outcome efficiency expectations.