• Jos Verbeek, Marie-José Sengers, Linda Riemens, and Joke Haafkens.
• Coronel Institute for Work, Environment and Health, Amsterdam, The Netherlands. j.h.verbeek@amc.uva.nl
• Spine. 2004 Oct 15; 29 (20): 2309-18.

Study DesignA systematic review of qualitative and quantitative studies.ObjectivesTo summarize evidence from studies among patients with low back pain on their expectations and satisfaction with treatment as part of practice guideline development.Summary Of Background DataPatients are often dissatisfied with treatment for acute or chronic back pain.MethodsWe searched the literature for studies on patient expectations and satisfaction with treatment for low back pain. Treatment aspects related to expectations or satisfaction were identified in qualitative studies. Percentages of dissatisfied patients were calculated from quantitative studies.ResultsTwelve qualitative and eight quantitative studies were found. Qualitative studies revealed the following aspects that patient expectation from treatment for back pain or with which they are dissatisfied. Patients want a clear diagnosis of the cause of their pain, information and instructions, pain relief, and a physical examination. Next, expectations are that there are more diagnostic tests, other therapy or referrals to specialists, and sickness certification. They expect confirmation from the healthcare provider that their pain is real. Like other patients, they want a confidence-based association that includes understanding, listening, respect, and being included in decision-making. The results from qualitative studies are confirmed by quantitative studies.ConclusionsPatients have explicit expectations on diagnosis, instructions, and interpersonal management. New strategies need to be developed in order to meet patients' expectations better. Practice guidelines should pay more attention to the best way of discussing the causes and diagnosis with the patient and should involve them in the decision-making process.

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