Individual Expectation: An overlooked, but pertinent factor in the treatment of individuals experiencing MKS pain.

(Bialosky, Bishop, & Cleland, 2010)

Aims: 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.

Methods: Perspective = Expert opinion

Results: Expectations are associated with clinical outcomes, satisfaction, and influence of behaviour. 4 levels: Predictive = What he believes will happen, Ideal = what he wants, Normative = what should occur, or unformed = lack of preconceived notion. The current definition of expectation is highly variable. Expectation appears to be influenced by a number of individual factors; however, the influence of these factors may be specific to the situation and individual. Currently, the measurement of expectation is not standardized, and failure to fully clarify expectation may lead to confusion regarding measurement methods and numerous measurement approaches. Variability in the measurement of expectation has implications for the generalization of results among studies and from research to clinical practice, as self- report of expectation differs by the measurement tool used.

Despite these inconsistencies, an association exists between predicted expectations and outcomes related to musculoskeletal pain regardless of the method of measurement.

Studies suggest an association between predicted expectation and outcomes related to MSK pain conditions. Furthermore, they suggest a prognostic value for expectation in the treatment of individuals experiencing MSK pain that may surpass the type of treatment provided. Specifically, the exact intervention may not be as important as the individual expectation for the intervention.

Outcomes, therefore, may not depend wholly upon the type of treatment provided, but also are influenced by individual attitudes or beliefs regarding the treatment. Manipulation of expectation, as is common in the placebo literature, suggests a causative effect of expectation on pain-related outcomes that may translate to the clinical management of MSK pain conditions.

Limitations: Review

In practice: Considering expectations (Predictive and normative and not ideal) may help to choose among treatments with similar level of evidence to maximize effects.

Bialosky, J. E., Bishop, M. D., & Cleland, J. A. (2010). Individual Expectation: An Overlooked, but Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain. Physical Therapy, 90(9), 1345–1355.

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