Recent research confirms our previous intuitions, that expectations of recovery predict recovery from low back pain. See the full paper by Eklund et al here

My suggestions for managing patient expectations.

  1. Explore patients’ expectations at the first visit (before setting them!) & explore underpinning beliefs. Ask the patient flat out, for example “What are you expecting from seeing me today?”.
  2. Balance the therapeutic benefit of setting positive (‘great’) expectations of recovery with evidence, likelihood & realism.
  3. Emphasise & reflect on improvements in pain, disability & function at each visit.
  4. Frame ALL elements of the clinical encounter in a positive & reassuring way (eg pain experience, clinical findings, diagnosis, treatment explanations).
  5. Performing patients’ preferred/expected treatment interventions (eg manual therapy) initially (whilst ‘holding your nose’) & then reframing, empowering & educating towards other interventions, can develop trust & a therapeutic alliance necessary for ongoing successful management.
  6. Incorporating patient preferences, values and expectations is part of evidence-based decision-making and practice.

If you’re struggling to incorporate the latest evidence and biopsychosocial model into your management of low back pain, or struggling to use these models to shape your communication with patients- then check out my CPD courses on language and communication when managing low back pain.

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