Treating to Patient Expectations

                                                                                                                                                                                                                                                                                                                      We have discussed before about the potential effect of placebo. It can play quite a significant role and should never be discounted. Probably one of the specialties of PT that is most frequently challenged by a patient's prior expectations is the orthopaedic setting. Patients come in asking about the "wonders of ultrasound" or possibly kinesiotape after seeing their favorite athlete wear it all over their body. With the push for evidence-based practice, research has shown little support for these interventions, leading to many PT's tossing them out of their treatment options.

People often forget that one of the 3 pillars of evidence based practice is patient values. Patient expectation is a component of the patient values pillar. If a patient states they had success with one of the less-supported treatments in the past and they expect to receive it again, we should implement it. If we ignore it, the patient-clinician relationship could become compromised, leading to a lack of improvement. I recently have had some patients that expected Instrument-Assisted Soft Tissue Mobilization (IASTM) to be deeper and more forceful than I usually provide. Many of the brand names build their philosophy off of "realigning collage" or "initiating the inflammatory response," while current research states that amount of force is not necessary. When patients do expect that force, however, I typically increase the force I apply, but still not as intense as others. That doesn't mean it should be performed blindly. The unsupported treatments may be provided, but they should be coupled with different treatments that have more support. In application of a treatment, I'll educate the patient how the support behind the technique is limited, but we will couple it with components that have a stronger background of support.

With the advancements in pain science research, the power of the mind in its relation to pain is just beginning to be realized. If the patient is expecting certain aspects of treatment, we should consider incorporating it, otherwise the patient may "refuse" to get better. No single study can control for a patient's expectations, so no study is perfect. Next time a patient reports prior success with a certain mode of treatment, don't be so quick to set it aside.

-Chris

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