Setting Patient Expectations May Influence Treatment Outcomes for Healing

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Injury treatment and rehabilitation may seem more or less routine in the eyes of the practitioner, and it is easy to assume that an injured patient will be willing and compliant in the rehabilitation process. However, a recent analysis by Coronado et al. (2018) revealed an important link between pretreatment psychosocial factors and patient-reported outcomes, indicating that patient expectations may have a profound influence on the effectiveness of treatment.

The Research

  • The analysis reviewed data from 10 independent studies, with a total population of 1410 patients between the ages of 46-62 years, of whom 60% were male.
  • The studies included information that examined the association between psychosocial factors and patient-reported outcomes in patients with rotator cuff ruptures.
  • The review focused on associations between specific psychosocial factors and patient-reported measures, including function, disability, pain, and quality of life.
  • One psychosocial factor in particular, patient expectation, was linked to patient-reported post-treatment outcomes in two studies. It was found that the higher the patient’s expectations of benefit, the greater the perceived post-surgical benefit.
  • The authors concluded that patient expectations are important predictors of patient-reported outcomes, and that improved expectations are modifiable factors that can be improved in the healthcare environment for enhancing recovery.

What It All Means

Most of us have had a health care experience where we felt objectified, as though our perspective as an individual had no bearing on the chosen path of treatment or its outcome. Yet there is increasing evidence that the patient’s mindset plays an important role in the healing process.

In a recent article published in the British Medical Journal (Crum et al., 2017), the authors argue that patient mindset and social context can profoundly influence treatment outcomes, and that psychosocial factors affect every medical interaction.

A number of non-medical factors influence the patient’s psychosocial experience, including:

  • Patient trust in the provider and their perceived relationship
  • How well the provider listens to, engages and informs the patient
  • Branding, price and advertising of drugs or treatments
  • Reputation of the institution and practitioner
  • The patient’s expectations to heal
  • The body’s ability to heal itself naturally over time

The Important Role of Patient Expectations

The concept of the placebo response is not new in medicine. Study after study has shown that in many instances, a placebo can render the same outcomes as a pharmacological or surgical intervention. In fact, an estimated 60-90% of conditions ranging from pain to immune function to surgical recovery are influenced by patient mindset (Crum et al., 2017).

Despite universal awareness of the important role played by psychosocial factors in the healing process, little has been done to harness the healing powers of psychological and social elements and incorporate them as part of the medical experience. Yet evidence is mounting that a patient-provider relationship that includes empathy and understanding on the part of the caregiver produces measurable physiological changes that exceed the effects of treatment alone.

An empathetic caregiver can boost patient expectations, lower anxiety, and provide increased psychological support. The practitioner-patient relationship can affect health both directly by influencing physiological responses, and indirectly by improving patient adherence and reducing the demand for unnecessary treatment.

Patient Experience at NYDNR

At NYDNRehab, we value the importance of our patients’ feedback, and we make every effort to cultivate a positive relationship with each patient. Our treatment approaches are always individualized, taking into consideration your needs, preferences and concerns. Our goals are to relieve pain, restore function, boost performance and build a long-lasting relationship with every patient we treat.

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Resources

Coronado, Rogelio A., et al. “Are Psychosocial Factors Associated With Patient-reported Outcome Measures in Patients With Rotator Cuff Tears? A Systematic Review.” Clinical Orthopaedics and Related Research® 476.4 (2018): 810-829.

Crum, Alia J., Kari A. Leibowitz, and Abraham Verghese. “Making mindset matter.” Bmj 356 (2017): j674.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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