Message for the clinic: what is the ‘take-home’ message for the
clinician?
- Understanding the patient expectation is important for patient centred
approach in practice
- Patient expectations positively influence pain intensity among low
back pain patients
- The review highlights various challenges in evaluating patient
expectations in clinical practice
Introduction
Patients’ expectations (PEs) are defined as a set of beliefs an
individual holds in regard to the treatment and its outcomes with an
anticipation that a given event is likely to happen as a consequence of
an intervention (1). In musculoskeletal practice, PEs are reported to be
a valuable predictors to treatment outcomes in patients with acute,
sub-acute and chronic low back pain (2, 3, 4). PEs have the potential to
influence outcomes regardless of the type of intervention (5). Patients
with higher expectations on the treatment sessions reported better
outcomes when compared to those with lower expectations who had showed
lesser improvements in their treatments particularly in terms of
disability, levels of functional activity and pain (5, 6, 7). Patients’
awareness of their expectations regarding their care is a potentially
crucial aspect in developing policies and delivering healthcare services
(8). Therefore, investigating the influence of positive and negative PEs
on treatment outcomes among people with CLBP may be beneficial for
clinical practice, as an understanding of these expectations from care
providers could arguably help them to better consider these expectations
in their clinical practice.
A huge heterogeneity exists in the literature with unclear terminologies
in terms of understanding the term ‘patient expectation’ (9-11). Patient
preference, treatment motivation, treatment credibility and
self-efficacy are some of the terms that have been used interchangeably
with the term patient expectation (9, 10). Yet some of these terms may
arguably be differentiated from PEs (8-10). Furthermore, the term PEs
have also been demonstrated as desires, wishes and hopes about the
future (11). However, it could be argued that an individual could desire
an event, yet, not expect it. Similarly, the term ‘patient hopes’ are
not similar to PE, as expectations are cognitive, while hopes are
motivational (12). Therefore, these differing terminologies will not be
included for consideration in this systematic review as these terms are
not true reflection of PEs. Also, the intention of this review is not to
focus on specific definitions and conceptualisations of PEs, instead the
review focuses to screen the evidence on how PEs are associated with
treatment outcomes among patients with low back pain. Thus in this
review, the term PEs includes the three concepts namely expectancy
probability, process expectations, and outcome expectations. It will
consider other 4 distinct types of expectations namely unformed, ideal,
predicted or normative, or value or probability expectations (13,14).
An international multidisciplinary panel in low back pain recommended
physical functioning, pain intensity and health-related quality of life
as the core outcome domains to be measured in people with LBP in
research papers and clinical practice (15). Thus in this review, the
impact of PEs were specifically focussed into these outcomes that are
related to functional status, pain and quality of life. Past systematic
reviews and existing evidences that investigated PEs have focussed on
outcomes such as limitation of daily living activities, absence from
work and return to work and supports an inconsistent association between
PEs on these outcomes among people with low back pain (16,17,18).
Therefore to our knowledge, no previous systematic review has addressed
the influence of PEs on functional status, pain and quality of life
among people with CLBP. Thus, the current review may claim originality
and significance in terms of shedding new evidence and knowledge to
clinicians on the influence of PEs on treatment outcomes related to
functional status, pain and quality of life. The significance of the
review finding may assist clinical practice and health care providers to
explicitly capture and document process of patient engagement in their
care set up and care process. Thus, the main objective of the systematic
review is to synthesise the evidence on the influence of PEs on the
treatment outcomes related to functional status, pain and quality of
life among people with low back pain. The current review would summarise
the evidence on the association between PEs on Physiotherapy
interventions and the treatment outcomes such as pain intensity,
functional status and quality of life among individuals with CLBP.
Methods
The review was conducted according to the reporting standards of the
PRISMA (the Preferred Reporting Items of Systematic Reviews and
Meta-Analyses guidelines for reporting systematic review findings)
guidelines (19,20).