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).