Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain

Marcus John Beasley; Elizabeth Alice Ferguson-Jones; Gary John Macfarlane; MUSICIAN Study team

doi:10.1080/24740527.2017.1384297

Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain

Marcus John Beasley, Elizabeth Alice Ferguson-Jones, Gary John Macfarlane, MUSICIAN Study team

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

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Abstract

Background

Patients’ beliefs and attitudes towards a treatment can affect treatment response. In unblinded trials this can affect outcomes.

Aims

The aim of this analysis was to examine the association between treatment preference and expectation, and outcome in a trial of pain treatments.

Methods

In a randomised trial (ISRCTN67013851) of four treatments for chronic widespread pain, participants were asked which they would prefer, and what improvement they expect from each. The proportion of participants reporting positive health outcomes at three time-points after treatment were compared between those matched or unmatched with their preference, and between those with and without expectation for improvement. Odds ratios were calculated adjusted for baseline characteristics associated with preference and expectation.

Results

442 participants were recruited to the trial (69.5% female). The proportion reporting positive outcome among participants matched to their preference compared to those unmatched was: 33.3% vs 34.4% at end of treatment (adjusted OR 0.80, 95% CI 0.44–1.46), 34.4% vs 29.0% at 3 months (aOR 1.23, 0.67–2.26), and 34.8% vs 30.3% at 2 years (aOR 1.31, 0.70–2.46). The proportion of participants reporting positive outcome among those expecting improvement compared to those not was: 36.6% vs 15.0% at end of treatment (aOR 2.03, 1.07–3.85), 34.1% vs 13.2% at 3 months (aOR 2.31, 1.22–4.38), and 32.8% vs 19.1% at 2 years (aOR 1.16, 0.67–2.36).

Conclusions

Treatment preference had no clear effect on outcomes, but expectation did. These results could inform future approaches to management, while researchers assessing treatments should take into account this expectation effect.

Original language	English
Pages (from-to)	161-170
Number of pages	10
Journal	Canadian Journal of Pain
Volume	1
Issue number	1
Early online date	11 Oct 2017
DOIs	https://doi.org/10.1080/24740527.2017.1384297
Publication status	Published - 2017

Keywords

placebo response
treatment preference
expectation
randomised controlled trials
treatment effect
non-specific effects

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10.1080/24740527.2017.1384297Licence: CC BY

Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain
© 2017 Marcus John Beasley, Elizabeth Alice Ferguson-Jones and Gary John Macfarlane. Published with license by Taylor & Francis.© 2017 Marcus John Beasley, Elizabeth Alice Ferguson-Jones and Gary John Macfarlane. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Final published version, 1.29 MBLicence: CC BY

Cite this

@article{38721f8cf6384e1790c6d95e905aca09,

title = "Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain",

abstract = "BackgroundPatients{\textquoteright} beliefs and attitudes towards a treatment can affect treatment response. In unblinded trials this can affect outcomes.AimsThe aim of this analysis was to examine the association between treatment preference and expectation, and outcome in a trial of pain treatments.MethodsIn a randomised trial (ISRCTN67013851) of four treatments for chronic widespread pain, participants were asked which they would prefer, and what improvement they expect from each. The proportion of participants reporting positive health outcomes at three time-points after treatment were compared between those matched or unmatched with their preference, and between those with and without expectation for improvement. Odds ratios were calculated adjusted for baseline characteristics associated with preference and expectation.Results442 participants were recruited to the trial (69.5% female). The proportion reporting positive outcome among participants matched to their preference compared to those unmatched was: 33.3% vs 34.4% at end of treatment (adjusted OR 0.80, 95% CI 0.44–1.46), 34.4% vs 29.0% at 3 months (aOR 1.23, 0.67–2.26), and 34.8% vs 30.3% at 2 years (aOR 1.31, 0.70–2.46). The proportion of participants reporting positive outcome among those expecting improvement compared to those not was: 36.6% vs 15.0% at end of treatment (aOR 2.03, 1.07–3.85), 34.1% vs 13.2% at 3 months (aOR 2.31, 1.22–4.38), and 32.8% vs 19.1% at 2 years (aOR 1.16, 0.67–2.36).ConclusionsTreatment preference had no clear effect on outcomes, but expectation did. These results could inform future approaches to management, while researchers assessing treatments should take into account this expectation effect.",

keywords = "placebo response, treatment preference, expectation, randomised controlled trials, treatment effect, non-specific effects",

author = "Beasley, {Marcus John} and Ferguson-Jones, {Elizabeth Alice} and Macfarlane, {Gary John} and {MUSICIAN Study team}",

note = "The following are members of the MUSICIAN study team: Gary Macfarlane (Principal Investigator), John McBeth (Investigator), Deborah Symmons (Investigator), Karina Lovell (investigator), Philip Keeley (Investigator), Phil Hannaford (Investigator), Chrysa Gkazinou (Trial manager), Marcus Beasley (Research Assistant), Elizabeth Jones (PhD student), Gordon Prescott (Statistician), and Steve Woby (Investigator). We are grateful to the practices and patients in Aberdeen city and Cheshire, which participated in the study: Carden medical centre, Elmbank medical practice, Great Western Road medical practice, Garthdee medical group, Readesmoor medical group practice, Lawton House surgery, Bollington medical practice, Park Lane surgery. The Scottish Primary Care Research Network facilitated access to patient information at the practices in Aberdeen city. Charlie Stockton was the study manager and Ashraf El-Metwally an Investigator during the setting up and for part of the conduct of the study. John Norrie was originally an investigator of the MUSICIAN study while Director of the Centre for Health Care Randomised Trials (CHART) at the University of Aberdeen. We are grateful for the input of members of the Health Services Research Unit (HSRU) at The University of Aberdeen in the conduct of the study: Alison MacDonald and Gladys McPherson. We are grateful to the project assistants who worked on the survey: Dev Acharya, Jennifer Bannister, Flora Joyce, Michelle Rein., Karen Kane, and Rowan Jasper. Alison Littlewood was responsible for study management at the Cheshire site. Finally, we thank the independent members of the trial steering committee (Professor Matthew Hotopf, Professor Tracey Howe, Professor Martin Underwood) and data monitoring committee (Dr. Marwan Bukhari, Professor Hazel Inskip, Dr. Chris Edwards). Funding details The study was funded by Arthritis Research UK, grant number 17292.",

year = "2017",

doi = "10.1080/24740527.2017.1384297",

language = "English",

volume = "1",

pages = "161--170",

journal = "Canadian Journal of Pain",

issn = "2474-0527",

publisher = "Taylor & Francis",

number = "1",

}

TY - JOUR

T1 - Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain

AU - Beasley, Marcus John

AU - Ferguson-Jones, Elizabeth Alice

AU - Macfarlane, Gary John

AU - MUSICIAN Study team

N1 - The following are members of the MUSICIAN study team: Gary Macfarlane (Principal Investigator), John McBeth (Investigator), Deborah Symmons (Investigator), Karina Lovell (investigator), Philip Keeley (Investigator), Phil Hannaford (Investigator), Chrysa Gkazinou (Trial manager), Marcus Beasley (Research Assistant), Elizabeth Jones (PhD student), Gordon Prescott (Statistician), and Steve Woby (Investigator). We are grateful to the practices and patients in Aberdeen city and Cheshire, which participated in the study: Carden medical centre, Elmbank medical practice, Great Western Road medical practice, Garthdee medical group, Readesmoor medical group practice, Lawton House surgery, Bollington medical practice, Park Lane surgery. The Scottish Primary Care Research Network facilitated access to patient information at the practices in Aberdeen city. Charlie Stockton was the study manager and Ashraf El-Metwally an Investigator during the setting up and for part of the conduct of the study. John Norrie was originally an investigator of the MUSICIAN study while Director of the Centre for Health Care Randomised Trials (CHART) at the University of Aberdeen. We are grateful for the input of members of the Health Services Research Unit (HSRU) at The University of Aberdeen in the conduct of the study: Alison MacDonald and Gladys McPherson. We are grateful to the project assistants who worked on the survey: Dev Acharya, Jennifer Bannister, Flora Joyce, Michelle Rein., Karen Kane, and Rowan Jasper. Alison Littlewood was responsible for study management at the Cheshire site. Finally, we thank the independent members of the trial steering committee (Professor Matthew Hotopf, Professor Tracey Howe, Professor Martin Underwood) and data monitoring committee (Dr. Marwan Bukhari, Professor Hazel Inskip, Dr. Chris Edwards). Funding details The study was funded by Arthritis Research UK, grant number 17292.

PY - 2017

Y1 - 2017

N2 - BackgroundPatients’ beliefs and attitudes towards a treatment can affect treatment response. In unblinded trials this can affect outcomes.AimsThe aim of this analysis was to examine the association between treatment preference and expectation, and outcome in a trial of pain treatments.MethodsIn a randomised trial (ISRCTN67013851) of four treatments for chronic widespread pain, participants were asked which they would prefer, and what improvement they expect from each. The proportion of participants reporting positive health outcomes at three time-points after treatment were compared between those matched or unmatched with their preference, and between those with and without expectation for improvement. Odds ratios were calculated adjusted for baseline characteristics associated with preference and expectation.Results442 participants were recruited to the trial (69.5% female). The proportion reporting positive outcome among participants matched to their preference compared to those unmatched was: 33.3% vs 34.4% at end of treatment (adjusted OR 0.80, 95% CI 0.44–1.46), 34.4% vs 29.0% at 3 months (aOR 1.23, 0.67–2.26), and 34.8% vs 30.3% at 2 years (aOR 1.31, 0.70–2.46). The proportion of participants reporting positive outcome among those expecting improvement compared to those not was: 36.6% vs 15.0% at end of treatment (aOR 2.03, 1.07–3.85), 34.1% vs 13.2% at 3 months (aOR 2.31, 1.22–4.38), and 32.8% vs 19.1% at 2 years (aOR 1.16, 0.67–2.36).ConclusionsTreatment preference had no clear effect on outcomes, but expectation did. These results could inform future approaches to management, while researchers assessing treatments should take into account this expectation effect.

AB - BackgroundPatients’ beliefs and attitudes towards a treatment can affect treatment response. In unblinded trials this can affect outcomes.AimsThe aim of this analysis was to examine the association between treatment preference and expectation, and outcome in a trial of pain treatments.MethodsIn a randomised trial (ISRCTN67013851) of four treatments for chronic widespread pain, participants were asked which they would prefer, and what improvement they expect from each. The proportion of participants reporting positive health outcomes at three time-points after treatment were compared between those matched or unmatched with their preference, and between those with and without expectation for improvement. Odds ratios were calculated adjusted for baseline characteristics associated with preference and expectation.Results442 participants were recruited to the trial (69.5% female). The proportion reporting positive outcome among participants matched to their preference compared to those unmatched was: 33.3% vs 34.4% at end of treatment (adjusted OR 0.80, 95% CI 0.44–1.46), 34.4% vs 29.0% at 3 months (aOR 1.23, 0.67–2.26), and 34.8% vs 30.3% at 2 years (aOR 1.31, 0.70–2.46). The proportion of participants reporting positive outcome among those expecting improvement compared to those not was: 36.6% vs 15.0% at end of treatment (aOR 2.03, 1.07–3.85), 34.1% vs 13.2% at 3 months (aOR 2.31, 1.22–4.38), and 32.8% vs 19.1% at 2 years (aOR 1.16, 0.67–2.36).ConclusionsTreatment preference had no clear effect on outcomes, but expectation did. These results could inform future approaches to management, while researchers assessing treatments should take into account this expectation effect.

KW - placebo response

KW - treatment preference

KW - expectation

KW - randomised controlled trials

KW - treatment effect

KW - non-specific effects

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U2 - 10.1080/24740527.2017.1384297

DO - 10.1080/24740527.2017.1384297

M3 - Article

VL - 1

SP - 161

EP - 170

JO - Canadian Journal of Pain

JF - Canadian Journal of Pain

SN - 2474-0527

IS - 1

ER -

Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain

Abstract

Keywords

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