• Mark D Bishop, Paul E Mintken, Joel E Bialosky, and Joshua A Cleland.
• Department of Physical Therapy, University of Florida, Gainesville, FL, USA. 　bish@ufl.edu

Study DesignRetrospective cohort.ObjectivesThe objectives of this study were (1) to examine patients' general expectations for treatment by physical therapists and specific expectations for common interventions in patients with neck pain, and (2) to assess the extent to which the patients' general and specific expectations for treatment, particularly spinal manipulation, affect clinical outcomes.BackgroundPatient expectations can have a profound influence on the magnitude of treatment outcome across a broad variety of patient conditions.MethodsWe performed a secondary analysis of data from a clinical trial of interventions for neck pain. Prior to beginning treatment for neck pain, 140 patients were asked about their general expectations of benefit as well as their specific expectations for individual interventions. Next, we examined how these expectations related to the patients' ratings of the success of treatment at 1 and 6 months after treatment.ResultsPatients had positive expectations for treatment by a physical therapist, with more than 80% of patients expecting moderate relief of symptoms, prevention of disability, the ability to do more activity, and to sleep better. The manual therapy interventions of massage (87%) and manipulation (75%) had the highest proportion of patients who expected these interventions to significantly improve neck pain. These were followed by strengthening (70%) and range-of-motion (54%) exercises. Very few patients thought surgery would improve their neck pain (less than 1%). At 1 month, patients who were unsure of experiencing complete pain relief had lower odds of reporting a successful outcome than patients expecting complete relief (odds ratio [OR] = 0.33; 95% confidence interval [CI]: 0.11, 0.99). Believing that manipulation would help and not receiving manipulation lowered the odds of success (OR = 0.16; 95% CI: 0.04, 0.72) compared to believing manipulation would help and receiving manipulation. Six months after treatment, having unsure expectations for complete pain relief lowered the odds of success (OR = 0.19; 95% CI: 0.05, 0.7), whereas definitely expecting to do more exercise increased the odds of success (OR = 11.4; 95% CI: 1.7, 74.7). Regarding self-reported disability assessed with the Neck Disability Index, patients who believed manipulation would help and received manipulation reported less disability than those who did not believe manipulation would help and both received manipulation (mean difference, -3.8; 95% CI: -5.9, -1.5; P = .006) and did not receive manipulation (mean difference, -5.7; 95% CI: -9.3, -2.1; P = .014). There was also an interaction between time and the expectation for complete relief.ConclusionGeneral expectations of benefit have a strong influence on clinical outcomes for patients with neck pain.Level Of EvidencePrognosis, level 2b-.

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