A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies

Persistent Link:
http://hdl.handle.net/10150/610275
Title:
A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies
Author:
Eaves, Emery R.; Sherman, Karen J.; Ritenbaugh, Cheryl; Hsu, Clarissa; Nichter, Mark; Turner, Judith A.; Cherkin, Daniel C.
Affiliation:
Group Health Research Institute; Department of Family and Community Medicine & School of Anthropology, University of Arizona; Department of Psychiatry & Behavioral Sciences and Department of Rehabilitation Medicine, University of Washington School of Medicine
Issue Date:
2015
Publisher:
BioMed Central Ltd
Citation:
Eaves et al. BMC Complementary and Alternative Medicine (2015) 15:12 DOI 10.1186/s12906-015-0531-9
Journal:
BMC Complementary and Alternative Medicine
Rights:
© 2015 Eaves et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
Collection Information:
This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.
Abstract:
BACKGROUND: The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy. METHODS: We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time. RESULTS: Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a "positive outcome". Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health. CONCLUSIONS: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.
EISSN:
1472-6882
DOI:
10.1186/s12906-015-0531-9
Keywords:
Chronic low back pain; Acupuncture; Chiropractic; Yoga; Massage; CAM; Expectations; Self-care; Pain management
Version:
Final published version
Additional Links:
http://www.biomedcentral.com/1472-6882/15/12

Full metadata record

DC FieldValue Language
dc.contributor.authorEaves, Emery R.en
dc.contributor.authorSherman, Karen J.en
dc.contributor.authorRitenbaugh, Cherylen
dc.contributor.authorHsu, Clarissaen
dc.contributor.authorNichter, Marken
dc.contributor.authorTurner, Judith A.en
dc.contributor.authorCherkin, Daniel C.en
dc.date.accessioned2016-05-20T09:02:52Z-
dc.date.available2016-05-20T09:02:52Z-
dc.date.issued2015en
dc.identifier.citationEaves et al. BMC Complementary and Alternative Medicine (2015) 15:12 DOI 10.1186/s12906-015-0531-9en
dc.identifier.doi10.1186/s12906-015-0531-9en
dc.identifier.urihttp://hdl.handle.net/10150/610275-
dc.description.abstractBACKGROUND: The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy. METHODS: We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time. RESULTS: Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a "positive outcome". Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health. CONCLUSIONS: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.en
dc.language.isoenen
dc.publisherBioMed Central Ltden
dc.relation.urlhttp://www.biomedcentral.com/1472-6882/15/12en
dc.rights© 2015 Eaves et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)en
dc.subjectChronic low back painen
dc.subjectAcupunctureen
dc.subjectChiropracticen
dc.subjectYogaen
dc.subjectMassageen
dc.subjectCAMen
dc.subjectExpectationsen
dc.subjectSelf-careen
dc.subjectPain managementen
dc.titleA qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapiesen
dc.typeArticleen
dc.identifier.eissn1472-6882en
dc.contributor.departmentGroup Health Research Instituteen
dc.contributor.departmentDepartment of Family and Community Medicine & School of Anthropology, University of Arizonaen
dc.contributor.departmentDepartment of Psychiatry & Behavioral Sciences and Department of Rehabilitation Medicine, University of Washington School of Medicineen
dc.identifier.journalBMC Complementary and Alternative Medicineen
dc.description.collectioninformationThis item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.en
dc.eprint.versionFinal published versionen
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