I always try to look for ways to improve treatment outcomes for my patients. Whether that means learning new treatment techniques, exploring with new exercises, delving into medical history and other contributing factors, or helping them set alarms on their phones to remind them to do their home exercise program. One important factor to examine when aiming for better treatment outcomes is whether the patient expects to improve in response to treatment.
We all know the scope and importance of addressing the global health challenge that low back pain presents. Chronic low back pain leads to astronomically high healthcare costs, both in dollars toward appointments, imaging, procedures, as well as lost productivity and wages secondary to both short and long-term disability.
Examining all aspects of the identification, prevention, and treatment of low back pain should be in the forefront of our minds as healthcare professionals. One cheap and easy way to address some of these points is to work on developing positive expectations of treatment outcomes.
It’s a common idea that if you start something with the belief that it’s not going to work for you, there’s a pretty good chance that it won’t. This would suggest that if you start off believing that same thing WILL work for you, there’s a better chance of it working. Researchers in Sweden put this idea to the test in an article published in 2019 in the European Journal of Pain (found here).
They followed 593 patients with low back pain, and found that patients with a high expectation of improvement after their first visit were 58% more likely to report improvement at visit four. These findings were independent of variations in baseline pain intensity, psychological profile, and self-rated health.
I love reading about studies like this, because I believe that there is so much more to healing than the physical acts of soft tissue and joint mobilizations, stretching, and strengthening exercises. Beliefs about what Physical Therapy can and cannot do, prior experience with PT (whether good or bad), past experiences with chronic pain and/or pain that resolves on its own; all of these things, and many more, play a huge role in healing, well-being, and overall return to function. Using this reasoning, practitioners are truly able to influence their patients’ treatment outcomes before even starting to treat their dysfunction with traditional manual and/or exercise techniques.
I will certainly be putting more emphasis on improving my patients’ expectations during my initial evaluations, and perhaps findings like these will have you doing the same.