Patient Expectations of Physical Therapy and How It Influences Patient Outcomes
By: Cheryl “Chae” Dimapasoc Canon, PT, DPT; OptimisPT Director of Implementation and Compliance
Healthcare expectations are a modifiable factor corresponding to clinical outcomes in individuals presenting with pain and represent both a prognostic factor and a potential treatment target (Constantino, Arnkoff, Glass, Ametrano, Smith, 2011; Soroceanu, Ching, Abdu, McGuire, 2012). Identifying the elements that shape the pain experience and subsequent clinical outcomes are necessary to maximize current treatments and direct future ones. Patient expectations is one of the elements that need to be considered.
There are many research articles that have identified that patients with high expectations of therapy outcomes are likely to have greater improvement in their symptoms compared to those with lower expectations (Bishop et al 2013, Myers et al 2007, Linde et al 2007). The clinician’s expectations about the likely effectiveness of an intervention can also influence how effective the patient thinks it is going to be (Bialosky et al 2008). If the patient has low expectations of physical therapy, you can identify why the patient may have these low expectations and address them specifically; hopefully helping to achieve improved outcomes. Negative emotions often outweigh positive ones so identifying negative thoughts and low expectations early on are crucial to achieving good outcomes.
There are many factors to consider when thinking about patient expectations, including the fact that they may be very different from your expectations as the therapist. If treatment success is highly dependent upon patient outcomes, this should be a question included in every patient initial evaluation, but can be phrased in different ways: “What do you hope to get out of physical therapy?”
Expectations are not only specific to the overall outcome. Expectations may also be related to a specific intervention or approach to treatment. For example, the patient may have the expectation that “massage would help the most”, when coming to therapy, not understanding the full depth of what a physical therapist can provide. If he/she expects to receive a massage every visit and does not understand the importance of their HEP, activity modification and other factors that would help to achieve long-term improvement, it may be more challenging to achieve the desired outcomes.
The better you are able to understand what the patient “thinks” will happen, the better you can align your intervention strategies with their expectations and goals. For example, if a patient has negative feelings and poor expectations with spinal manipulation/Gr V high velocity, low amplitude mobilization, you may have to talk through these feelings and potentially even reconsider your intervention to align with the patient’s needs.
As the patient goes through their therapy episode of care, their expectations may change. New patient expectations may develop because previously they thought their goals were unattainable, but they progressed better than they thought! This emphasizes the need to continually seek to understand your patient throughout the episode of care. One way to do this is to, not only engage your patient in creating long-term functional goals, but reviewing them frequently with the patient and communicating where they are in their objective and functional journey toward those goals.
If a patient believes a treatment will work there is a strong likelihood that they will have a positive outcome from that treatment. The more educated they are on their condition, prognosis, your intervention and how it would help toward achieving their goals, as well as the patient’s role in the plan of care, the better and more likely they are to achieve good outcomes. In a study by Bialosky et al 2008, patients who received positive expectations from the clinician reported reduced pain perception and patients who received negative expectations reported increased pain perception.
If it isn’t a part of your regular workflow in the initial evaluation, it is highly recommended that your patient’s expectations of physical therapy intervention be included and reassessed throughout the episode of care.