{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:49:49Z","timestamp":1789487389952,"version":"build-2803163510"},"reference-count":67,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Sophies Minde AS"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,26]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To evaluate patients\u2019 expectations of pain improvement before randomisation (T\n                      <jats:sub>1<\/jats:sub>\n                      ) and after the first treatment (T\n                      <jats:sub>2<\/jats:sub>\n                      ), and to examine how expectations at these two time points were associated with pain outcome measured at 3\u2009months (T\n                      <jats:sub>3<\/jats:sub>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Exploratory secondary analyses of a three-arm, randomised controlled feasibility trial in patients with tennis elbow comparing heavy slow resistance training, shock wave therapy and advice (1:1:1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Outpatient clinic at Oslo University Hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults with lateral epicondylalgia, commonly known as tennis elbow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>\n                      Expected pain was rated on a Numeric Rating Scale (NRS, 0\u201310) at T\n                      <jats:sub>1<\/jats:sub>\n                      and T\n                      <jats:sub>2<\/jats:sub>\n                      . Present pain (NRS, 0\u201310) was reported at 3\u2009months (T\n                      <jats:sub>3<\/jats:sub>\n                      ). Changes in expectations from T\n                      <jats:sub>1<\/jats:sub>\n                      to T\n                      <jats:sub>2<\/jats:sub>\n                      were summarised descriptively. Univariable linear regressions assessed associations between T\n                      <jats:sub>3<\/jats:sub>\n                      pain and expectations at T\n                      <jats:sub>1<\/jats:sub>\n                      and T\n                      <jats:sub>2<\/jats:sub>\n                      , treatment group and baseline factors. Explained variance was quantified by R\n                      <jats:sup>2<\/jats:sup>\n                      . Multivariable models including demographics and baseline pain were evaluated via adjusted R\n                      <jats:sup>2<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty-four participants were included. In the shock wave group, nine (47%) came to expect greater improvement from T\n                      <jats:sub>1<\/jats:sub>\n                      to T\n                      <jats:sub>2<\/jats:sub>\n                      ; by contrast, in the advice group, seven (41%) expected less improvement. Expectations at T\n                      <jats:sub>1<\/jats:sub>\n                      were not associated with T\n                      <jats:sub>3<\/jats:sub>\n                      pain, whereas expectations at T\n                      <jats:sub>2<\/jats:sub>\n                      were positively associated with T\n                      <jats:sub>3<\/jats:sub>\n                      pain (b=0.61, 95%\u2009CI 0.33 to 0.89, p&lt;0.01, R\n                      <jats:sup>2<\/jats:sup>\n                      =0.27), suggesting that higher expected pain at T\n                      <jats:sub>2<\/jats:sub>\n                      was associated with higher reported pain at T\n                      <jats:sub>3<\/jats:sub>\n                      . Adding education and baseline pain increased explained variance modestly (R\n                      <jats:sup>2<\/jats:sup>\n                      from 0.27 to 0.32).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this study, expectations measured after randomisation and one treatment session were associated with pain at 3\u2009months for patients with tennis elbow. Larger, prospectively designed studies should investigate how postrandomisation expectations relate to clinical outcomes in non-blinded musculoskeletal trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04803825\">NCT04803825<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-122686","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T14:00:55Z","timestamp":1789480855000},"page":"e122686","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Patient expectations assessed before randomisation and after the first treatment session, and their associations with pain outcome at 3 months in patients with tennis elbow: a secondary analysis of a randomised controlled feasibility trial in Norwegian secondary care"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct04803825","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04803825","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9622-4636","authenticated-orcid":false,"given":"H\u00e5kon","family":"Sveinall","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5186-0674","authenticated-orcid":false,"given":"Cecille","family":"R\u00f8e","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaia B","family":"Engebretsen","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid","family":"Skatteboe","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Are Hugo","family":"Pripp","sequence":"additional","affiliation":[{"name":"Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway"},{"name":"Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, 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