| 1. Identify the most powerful non-specific treatment components (ie, those that have the largest effect on patient outcomes) | Patients experience less back-related disability after treatment for LBP when non-specific components are more positive, ie, when:
The therapeutic alliance is stronger and practitioner communication is more patient-centred The healthcare environment is experienced by patients as pleasant, accessible and convenient, and by practitioners as supportive Appointment duration is longer Patients expect their treatment to be effective, perceive it as credible and suitable for them personally and have few concerns about it Practitioners have a biopsychosocial orientation to back pain and expect patients to respond well to treatment
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| 2. Compare the magnitude of non-specific effects across orthodox (physiotherapy) and CAM (osteopathy, acupuncture) therapies |
CAM therapies (acupuncture and osteopathy) produce larger non-specific effects than orthodox therapy (physiotherapy) Differences between therapies are more pronounced in the NHS than in the private sector8–10
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| 3. Test that theoretically derived mechanistic pathways explain the effects of non-specific components | Non-specific components reduce patients’ back-related disability via:
Improvements in patients’ pain beliefs (eg, reduced fear of pain) Increases in patients’ self-efficacy for coping with pain Increased implementation of theory-specific lifestyle advice
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| 4. Identify similarities and differences in patient–practitioner interactions across the three therapies |
Acupuncture and osteopathy consultations score higher than physiotherapy consultations on an index of ‘patient-centeredness’ Patients who receive consultations that score higher on the patient-centeredness index report more positive outcomes than patients who receive consultations that score lower on the patient-centeredness index Consultations in the private sector score higher than those in the NHS on the patient-centeredness index12–14
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