A healthcare provider’s beliefs about a particular treatment may have a strong influence on the patient outcomes, according to a study published in the Journal of Pain Research.
“We found that as long as the provider had a strong preference for an intervention, the person got better, independent of which back pain treatment they received,” said lead investigator Mark Bishop, PhD, University of Florida College of Public Health and Health Professions, Gainesville, Florida.
Previous research has found that when patients receive a treatment option they prefer, they generally have better health outcomes. For the current study, the researchers wanted to explore how providers’ beliefs might impact outcomes for patients receiving manual therapies commonly used by physical therapists, chiropractors, and osteopathic practitioners for treating low back pain.
Participants included 60 adults who were not currently having back pain. They were put through a vigorous back exercise routine designed to induce temporary muscle soreness. They were then randomised to receive 1 of 2 types of manual therapy 48 hours after the back exercises.
Before treatment, participants were given written information and photographs describing the treatments and asked to complete a questionnaire on their treatment preference. They were asked to rate the intensity of their low back pain before and after treatment using a 101-point scale where 0 is no pain and 100 is the worst pain imaginable.
The providers included 2 physical therapists and 1 chiropractor who were trained in the specific treatment techniques. The providers’ verbal instructions to the participants were scripted so that all participants received similar information. The treatment involved 1 visit that lasted approximately 20 minutes. The amount of contact between provider and participants were the same across all interactions.
The providers also completed a questionnaire asking them to indicate which of the treatments he or she preferred. One provider had no strong preference and the other 2 providers indicated a preference for one of the therapies.
As expected, participants who were given a treatment they preferred reported better pain relief. But researchers were surprised by the provider findings.
“What we found wasn’t at all what we expected,” said Dr. Bishop. “We found that if the provider had a strong preference for an intervention, that preference had an even bigger influence on outcome. We hypothesise that this influence is due to a very strong sense of self-efficacy– they believed very strongly in their ability to help the participant with a specific technique.”
Participants who received a treatment from a provider who had a strong preference for that treatment were 68 times more likely to meet their expectations for pain relief.
According to Dr. Bishop, since the providers were following a script, the differences in participant outcomes may be attributable to other nonspecific factors, such as tone or body language that may communicate subtly to the participant that the provider is confident in his or her ability to provide the treatment.
The authors said more research is necessary with larger numbers of participants and providers to understand the provider factors that might influence patient health outcomes. Because the researchers evaluated participants who did not have back pain before the study, the findings may not be the same for patients who experience chronic low back pain.
Still, Dr. Bishop believes there are some important takeaways from the current study that providers can use in their practices.
“Let’s say there are 2 treatments that can help your patient’s pain,” he said. “If each of those treatments works about the same and you are confident in providing those treatments, then you should give the patient the opportunity to choose one of those treatments.”