Individual Expectation: An Overlooked, But Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain
Joel E. Bialosky Mark D. Bishop Joshua A. Cleland
Department of Physical Therapy,
University of Florida,
Gainesville, FL 32610-0154, USA
Physical therapists consider many factors in the treatment of patients with musculoskeletal pain. The current literature suggests expectation is an influential component of clinical outcomes related to musculoskeletal pain for which physical therapists frequently do not account. The purpose of this clinical perspective is to highlight the potential role of expectation in the clinical outcomes associated with the rehabilitation of individuals experiencing musculoskeletal pain. The discussion focuses on the definition and measurement of expectation, the relationship between expectation and outcomes related to musculoskeletal pain conditions, the mechanisms through which expectation may alter musculoskeletal pain conditions, and suggested ways in which clinicians may integrate the current literature regarding expectation into clinical practice.
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Physical therapy interventions for musculoskeletal pain conditions often address impairments with the implication that pain and function will improve in response to stretching a tight muscle or strengthening a weak muscle. Realistically, the mechanisms through which physical therapy interventions alter musculoskeletal pain are likely multifaceted and dependent upon a variety of factors related to the therapist, the patient, and the environment.  The current literature indicates factors other than the correction of physical impairments influence clinical outcomes in the conservative management of patients experiencing musculoskeletal pain. For example, psychological factors such as fear are useful in directing treatment. [2, 3] Similarly, factors related to patient expectations are associated with both clinical outcomes, [4, 5] satisfaction with treatment, [6, 7] and influence of behavior. [8, 9]
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The purpose of this perspective article is to review the influence of expectation in current physical therapist practice for the treatment of individuals experiencing musculoskeletal pain. First, we will define expectation as related to health outcomes and discuss the measurement of expectation. Second, we will summarize the literature regarding expectation as a mediator of outcomes related to patients with musculoskeletal pain conditions and the mechanisms through which expectation may alter musculoskeletal pain. Third, we will discuss ways in which physical therapists may consider expectation in current practice, including how best to measure expectation and how to maximize treatment effects with expectation.