Patients' Expectations Before Initiation of Intrathecal Baclofen Treatment: A Longitudinal Study with 1-Year Follow-Up.
Stina Gunnarsson, Dag Lemming, Siw Alehagen and 3 others
PMID 36718657WHAT IT FOUND
Intrathecal baclofen improved spasticity, pain, and self-care, but patients' expectations were not met.
Overall satisfaction remained moderate to low. Clinicians must align realistic goals with individual expectations before treatment to avoid dissatisfaction despite clinical gains.
Key findings
01Patients reported higher expectations for spasticity, pain, and sleep than the actual outcomes achieved at one year.
02Self-care occupations were the most common focus of treatment goals, with improvements seen in both self-reporting and proxy-reported groups.
03Satisfaction with occupational performance was best explained by the change in performance, the gap between expectations and outcomes, and baseline health status.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Small sample size (29 patients) limits generalisability. Baclofen dose adjustments were not tracked, so it is unclear if patients reached a stable therapeutic dose. Complications and concomitant spasticity medications (like botulinum toxin) were not reported, which may influence results. Proxy-reported data may be less valid than self-reported data. Follow-up was limited to one year, which may be insufficient for some patients to reach steady state.
The easy way to misread this
Do not assume that clinical improvements in spasticity or pain equate to patient satisfaction. This study found that even when symptoms improved, satisfaction remained moderate to low because patients' expectations were not met. Treating the numbers without addressing the expectation gap may lead to perceived treatment failure.