Exploring Congruence Between Patient and Clinician Expectations of Benefit in the Non-Surgical Management of Common Musculoskeletal Conditions in Tertiary Care.

Abstract

Background: Patient and clinician expectations of benefit from recommended management approaches may potentially impact the success of managing musculoskeletal conditions.

Methods: This was a multisite study in an advanced practice musculoskeletal service across Queensland, Australia. Relationships between patient and clinician (advanced physiotherapy practitioner) expectations of benefit, patient characteristics, and clinical outcome recorded 6 months later were explored with regression analysis in 619 patients undergoing non-surgical multidisciplinary care for either knee osteoarthritis (n = 286), low back pain (n = 249) or shoulder impingement syndrome (n = 84).

Results: Patient and clinician expectation ratings had a weak positive association (standardized coefficient (β) 0.28, adjusted R² 0.09). Higher patient expectation ratings were associated with higher readiness for change scores (β 0.31, model adjusted R² = 0.18), while higher clinician expectation ratings were associated with the condition managed, higher patient education level, lower potential presence of neuropathic pain or yellow flags, and more favourable radiological findings (model adjusted R² 0.4). Patient expectations and self-reported engagement with care were poorly correlated. Higher patient (β 0.33, adjusted R² 0.12) and clinician (β 0.32, adjusted R² 0.14) expectations were associated with better clinical outcomes. This positive association was stronger when patient and clinician expectation ratings were congruent.

Conclusions: Findings suggest that expected benefits from recommended care may impact outcomes and should be considered in the initial phases of management. In particular, congruence between patient and clinician expectations appears to have relevance to outcomes.