Most of the articles we cite as the basis of our practice have grounding in scientific principles. Beliefs and expectations are far less concrete but anyone who has set foot in any competition or rehab room knows full well that beliefs change the game. This area is clearly controversial given how difficult it is to measure and control for but is still worthy of investigation.
Verbbek, et al 2004 completed a review of patient expectation levels pre-treatment and satisfaction levels post-treatment for back pain. They found 12 qualitative studies and 8 quantitative studies. It was found many patients expect a clear diagnosis as to the cause of their back pain, a full examination and pain relief. This identifies why a percentage of the population always leaves dissatisfied. One cannot always find the source of the pain or always provide pain relief. One can understand why patients have these notions but in the event that diagnostic testing is inconclusive, it is important to explain why the tests are inconclusive and how treatment will proceed.
Haanstra, et al 2012 completed a review of patient expectations pre-operation for total hip and total knee replacements. Expectations concerning function, overall improvement, pain, stiffness and life satisfaction were measured. They included studies which included follow-up 6 weeks to 6 months post-op. Of the 2252 articles found 18 met all the inclusion criteria. Scores for patient expectations influencing outcomes varied from 6% to 79%. Thus it was inconsistent. The authors reported that definitions and standardized testing built into an underlying framework is lacking in this area. Clearly, if the answer is 6%, no real correlation exists but at 79% patient expectations play a major role in outcomes and should be maximized.
Holm, et al 2008 looked at patient expectations for recovery from whiplash injuries and patient outcomes. They mailed questionnaires to people who filed insurance claims in a prescribed period and sought treatment. From there, they reduced the number of participants given certain indications for severity of injury or if the patient self-eliminated. They were left with 1032 patients. Unlike the previous study, they found a high correlation between expectation and reality. Those who felt they would make little progress during rehabilitation had a 4.2 correlation with their disability score. Those who felt they would make moderate progress had a 2.0 disability score.
This field is not new but very under developed and anemic with studies. What it requires is a basic framework from which tools and questionnaires could be developed and tested to find patient’s expectation levels. If the expectation levels do in fact play a major role in rehabilitation and recovery, then psychological counseling and proper information early-on need to emphasized in future therapeutic interventions. This is an entire field of research just waiting for someone to grab it by the horns and take control in the same way Dr. Orlick changed the way we think of mental training in sport, someone needs to step up and put beliefs and expectations on the map for rehabilitation.