Outcome expectations in patients with persistent neck, back and shoulder complaints

Abstract

Over the last decades, research has gradually increased its focus on patients’ expectations and their potential clinical importance. Most noteworthy, perhaps, is the suggested association between patients’ expectations and treatment outcomes. The overall aims for the current thesis were to assess outcome expectations for pain and functioning among patients with persistent neck, back and shoulder complaints. Further, changes in expectations during a physical medicine and rehabilitation (PMR) appointment, as well as expectations influence on pain and functional improvement over six months, were assessed. Few musculoskeletal expectation measurements exist, hence, a questionnaire simultaneously measuring present and expected pain and function status on equal scales was constructed (PainFunction), and an existing measure (Patient Shoulder Outcome Expectancies (PSOE)) was translated to Norwegian. Both questionnaires were tested in a pilot study, and thereafter utilized to measure patients’ expectations. Both measures (PSOE and PainFunction) were shown to have acceptable reliability scores and were reported to be comprehensible by the patients during the pilot testing of the two questionnaires. Close to half the population (40%) expected their pain and functional status to remain unchanged by the time of their PMR appointment. Secondly, expectations were considered malleable, as approximately one-third of the patients had changed their expectations after the PMR appointment. The shoulder patients were more optimistic regarding improvement than patients with neck and back complaints. Apart from this, no close associations between expectations, or changes in expectations, and demographic or other individual factors were found. Lastly, patients’ expectations were not associated with pain and functional improvement after six months. However, the associations between expectations and outcome suffers from inconsistent evidence in the literature. Overall, for further improving our knowledge of clinical applicability of patients’ expectations, universal definitions and measurement methods are required in expectation studies to increase comparability among studies with greater precision.