patient expectations and treatment outcome (WC2010-004)

Background

Starting date: 26/10/2010

About 3 decades ago it was suggested that patient expectancies for improvement was an important variable affecting outcome. Lately, the role of treatment expectancy has gained increased attention in the field of musculoskeletal health and chronic pain. Several studies conclude that, although the associations found were low to modest, the results underscore the importance of expectancy for the outcome of different active interventions for cronic low back pain and might contribute to the development of more effective treatments.

Crow et al. (1999) performed an extensive review of the literature that focussed on patient expectancies but took a broad perspective, not focusing on a specific disease or treatment. Many studies in Crow’s review showed that positive outcome expectancies were associated with a more positive outcome of medical treatments. It is a tempting prospect that treatment effects could potentially be increased by influencing expectancies, but these recommendations are easier said than done. When thinking about these recommendations the following questions arise: What are realistic expectancies? If expectancies are ‘too high’ or ‘too low’, how can they be modified? What are the main features of the communication techniques that aim to modify expectancies? What if the patients do not want to become actively involved in their treatment? Therefore Crow et al. (1999) recommended future research into the psychological issues regarding patient expectancies and mechanisms by which patient expectancies are translated into health outcomes.A theoretical model to guide future research into the mechanisms of patient expectancies within the framework of treatment settings is a prerequisite. This is more valuable than continuing with research which merely adds to the inventory of demonstrable patients expectancies effects.