Across the individual studies, the ORs were all greater than 1.00 and almost all were statistically significant, indicating robust evidence from this meta-analysis (Lewis and Clarke, 2001). This result was also still evident when more rigorous eligibility criteria were applied to ensure only high quality studies ZD6474 price were contributing data to the meta-analysis. No indication of publication bias was shown by our analysis (Egger et al 1997). However, as a consequence of the limited number of studies on which the scatter plot was based, our conclusion with respect to publication bias is preliminary (Lau et al 2006). Another limitation

of this review is that, although low back pain is a multifactorial problem, only one potential prognostic factor was examined. All measures of participants’ recovery expectations were carried out within Alectinib purchase the first three months of non-specific low back pain. However, in contrast to Burton et al (2003)

and lies et al (2009), in this review strength of prediction was not related to time of measurement within these three months. Moreover, Steenstra et al (2005) provided the largest effect size despite patients’ expectations being measured within two days of the onset of the pain. We recommend that physiotherapists screen patients’ expectations in the acute stage of low back pain so that strategies can be targeted to those most at risk of absence from work in below a given period due to progression of their low back pain into the chronic phase. For example, we suggest counselling patients with more negative

expectations and the development of guidelines to screen patients’ recovery expectations as a psychological construct. An effective coaching strategy can affect how patients handle their recovery expectations (lies et al 2011). A number of studies substantiated the need for screening, and if necessary, for quick intervention by providing information directly after onset (Perrot et al 2009, Kapoor et al 2006, Pengel et al 2003, Linton and Hallden, 1998). Thus, in future research, patients’ expectations should be included in a core set of factors predicting chronic low back pain. Interpreting low recovery expectations of a patient is difficult due to the complex mental states that underlie an individual’s expectations (Cedraschi and Allaz, 2005, Baxter et al 2008, Henschke et al 2008). Although different measurement tools were used in the included studies, it may be worth considering the problems that patients encounter when describing their expectations. This might influence the content validity of the construct and future research should be focussed on interpretation of this construct. There is a need for further studies to develop a specific measurement instrument for patients’ expectations. Determination of a sound definition of the construct might be a first step to develop such an instrument.

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