Outcome predictive value of psychosocial variables
The objective of this study was to determine whether treatment outcome expectancy, treatment credibility, locus of control, and fear avoidance beliefs predict treatment success of manual therapy and physical therapy for patients with non-specific neck pain. This study is a secondary analysis of a randomized controlled trial conducted in primary care practices in The Netherlands. It was found that outcome expectancy in patients with non-specific neck pain has additional predictive value for treatment success above and beyond clinical and demographic variables.
Numerous studies in the fields of rehabilitation, psychotherapy and less in physiotherapy have shown that expectations of both patient and therapist regarding treatment outcome may affect the prognosis of (chronic) pain, particularly musculoskeletal pain. The underlying theory of treatment outcome expectancy attempts to explain the relationship between expectations and outcomes. This theory states that not only a patient’s expectations but also the physiotherapist’s expectations will affect their experiences positively or negatively in relation to clinical outcomes.
There are indications that, at present, many physiotherapists perform their clinical assessment for (chronic) musculoskeletal pain mainly based on biomedical and somatic features. Moreover, they feel unprepared to treat patients with chronic pain by exploring psychosocial factors, particularly expectancy and credibility, that influence recovery in functioning and treatment outcome.
The physiotherapist’s awareness of changing behavior is growing. That is the beginning of the change. Physiotherapists use many treatment modalities based on biomedical principles and different techniques to change behavior. Mostly it is happening unsystematically. Physiotherapists are insufficiently informed of the underlying psychological theories in relation to physical activities and functioning.
> From: Groeneweg et al., Scand J Pain 14 (2017) 44-52. All rights reserved to Scandinavion Association for the Study of Pain. Click here for the online summary.