Pichonnaz C1,2, Ancey C1, Mbarga J3, Foley R-A3
1School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Physiotherapy, Lausanne, Switzerland, 2University Hospital of Lausanne, Department of Musculoskeletal Medicine, Lausanne, Switzerland, 3School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Health Research Unit, Lausanne, Switzerland
Background: Patients with non-specific chronic low back pain (NSCLBP) have to face a long-lasting, painful and potentially disabling condition. In the absence of visible damage and physical explanations about the pain origin, they may feel poor social recognition and disbelief. It is essential to grasp what they expect specifically from physiotherapists in this context, as the influence of expectations on clinical decision making, relationship and outcome have been previously highlighted.
Purpose: The aim of this study is to identify NSCLBP patients´ expectations toward physiotherapists before a 3-week rehabilitation program, and their perceived fulfilment 1 month after the program.
Methods: A purposeful sample of 20 patients (9♀ , 11♂ , 41.0±10.5 years, 4.3±3.5 symptoms duration, 3 on sick leave, 2 professional retraining) participated to semi-structured interviews conducted by anthropologists before and after the program. The first and last individual treatments of 10 patients were also observed. The qualitative data were crossed with the clinical data. Coding was performed with Atlas.tiR, crossed content analysis was performed by two anthropologists and two physiotherapists.
Results: The objectives of the majority of the patients were in line with those of the program. Patients were mainly expecting an active program. Though pain reduction was the most expected outcome, strengthening, return to valued activities, and improved well-being were awaited too. Patients expected physiotherapists to deal essentially with physical issues, and to provide a functional diagnosis about their problem. They were also waiting for counselling, explanations and skill development to deal with NSCLBP. Technical, gestural and relational individualization were strongly expected during individual sessions, while social support was expected from group sessions. Relational expectations essentially included listening, mutual trust, support and personalization. Yet, patients opinions diverged if physiotherapists should address emotional issues or not.
Most patients considered that their expectations had been met during the program. However, they were unmet when rehabilitation goals and patient´s goals diverged.
Physiotherapists were generally not held responsible for unmet outcome expectations, as long as they showed personal involvement and attention to the patient.
Observations showed that expectations and given responses were often indirectly formulated.
Conclusion(s): The mentioned expectations are specific to a sample of experienced patients who were admitted to a NSCLBP rehabilitation program. Patient´s adherence to the program goals was fundamental to expectations´ fulfilment. Patients´ expectations converged toward notions of patient-centred care and building up a personalized therapeutic alliance with the physiotherapist. Patients differentiated the fulfilment of expectations toward the program outcome from those toward the physiotherapist. In case of mitigated rehabilitation outcome, they considered their expectations toward him/her as met if he/she showed commitment and adaptation to their person and situation. More research is needed to understand factors that shape and influence patients´ expectations.
Implications: Awareness of patients´ expectations and discussion around them might contribute to optimize reciprocal therapeutic and relational adjustment between the patient and the physiotherapist. Physiotherapists have to help expectations be clarified, as they are often indirectly expressed. Accounting for expectations might contribute to improve the patient´s sense of recognition and the achievement of rehabilitation goals.
Keywords: Low back pain, Qualitative research, Expectation
Funding acknowledgements: Scientific Commission of Health Research of the University of Applied Sciences and Arts Western Switzerland
Purpose: The aim of this study is to identify NSCLBP patients´ expectations toward physiotherapists before a 3-week rehabilitation program, and their perceived fulfilment 1 month after the program.
Methods: A purposeful sample of 20 patients (9♀ , 11♂ , 41.0±10.5 years, 4.3±3.5 symptoms duration, 3 on sick leave, 2 professional retraining) participated to semi-structured interviews conducted by anthropologists before and after the program. The first and last individual treatments of 10 patients were also observed. The qualitative data were crossed with the clinical data. Coding was performed with Atlas.tiR, crossed content analysis was performed by two anthropologists and two physiotherapists.
Results: The objectives of the majority of the patients were in line with those of the program. Patients were mainly expecting an active program. Though pain reduction was the most expected outcome, strengthening, return to valued activities, and improved well-being were awaited too. Patients expected physiotherapists to deal essentially with physical issues, and to provide a functional diagnosis about their problem. They were also waiting for counselling, explanations and skill development to deal with NSCLBP. Technical, gestural and relational individualization were strongly expected during individual sessions, while social support was expected from group sessions. Relational expectations essentially included listening, mutual trust, support and personalization. Yet, patients opinions diverged if physiotherapists should address emotional issues or not.
Most patients considered that their expectations had been met during the program. However, they were unmet when rehabilitation goals and patient´s goals diverged.
Physiotherapists were generally not held responsible for unmet outcome expectations, as long as they showed personal involvement and attention to the patient.
Observations showed that expectations and given responses were often indirectly formulated.
Conclusion(s): The mentioned expectations are specific to a sample of experienced patients who were admitted to a NSCLBP rehabilitation program. Patient´s adherence to the program goals was fundamental to expectations´ fulfilment. Patients´ expectations converged toward notions of patient-centred care and building up a personalized therapeutic alliance with the physiotherapist. Patients differentiated the fulfilment of expectations toward the program outcome from those toward the physiotherapist. In case of mitigated rehabilitation outcome, they considered their expectations toward him/her as met if he/she showed commitment and adaptation to their person and situation. More research is needed to understand factors that shape and influence patients´ expectations.
Implications: Awareness of patients´ expectations and discussion around them might contribute to optimize reciprocal therapeutic and relational adjustment between the patient and the physiotherapist. Physiotherapists have to help expectations be clarified, as they are often indirectly expressed. Accounting for expectations might contribute to improve the patient´s sense of recognition and the achievement of rehabilitation goals.
Keywords: Low back pain, Qualitative research, Expectation
Funding acknowledgements: Scientific Commission of Health Research of the University of Applied Sciences and Arts Western Switzerland
Topic: Disability & rehabilitation; Musculoskeletal: spine; Professional practice: other
Ethics approval required: Yes
Institution: Faculté de biologie et médecine de l'université de Lausanne
Ethics committee: Human Research Ethics Committee of the Canton of Vaud (CER-VD)
Ethics number: protocol number 22/14
All authors, affiliations and abstracts have been published as submitted.
