Patients’ expectations of physiotherapists before and after an intensive chronic low back pain rehabilitation programme: a qualitative study based on semi-structured interviews and observations

Abstract

Purpose

To investigate the expectations regarding physiotherapists of patients attending an interdisciplinary CLBP rehabilitation programme and the response to these expectations.

Materials and methods

A thematic analysis was conducted, based on interviews of working-age patients with CLBP and without significant comorbidities.

Results

Twenty patients participated (9 male, 11 female, aged 21–58 years; symptoms duration 4.3 ± 3.0 years; pain VAS 53 ± 21 mm). Patients expected to learn pain and activity management. Expected outcomes were a reduction of pain, increased well-being and a return to normality. A collaborative approach involving therapeutic and relational adaptation was expected. Despite divergences concerning emotional aspects, patients expected a large range of applied psychosocial skills.

The programme met the expectations of most patients, especially when its goals matched those reported by the individuals. For most participants, the pain relief was below expectations. Active therapies were valued. After the programme, patients felt more ready to take responsibility for their back.

Conclusion

The expectation of developing self-management skills was prevalent. Expected treatments were mostly compatible with recommendations. Expectations to resume activities and decrease pain were in line with the rehabilitation goals, although the expected reduction in pain was overestimated. Relational expectations converged towards patient-centred care.

IMPLICATIONS FOR REHABILITATION

• Patient–therapist agreement on rehabilitation goals is central to meeting the expectations of patients following a chronic low back pain (CLBP) rehabilitation programme.

• Physiotherapists should be aware of the wide range of expectations that patients with CLBP have of them in terms of skills development, relationship and outcome.

• The treatments expected by patients with CLBP were mostly compatible with scientific treatment recommendations.

• Since expectations are rarely expressed spontaneously during treatment sessions, physiotherapists should regularly enquire about them and their evolution in the course of rehabilitation.

• Following the programme, the patients’ expectations had shifted from focusing on the physiotherapist to taking responsibility for self-management of the CLBP, although they had some doubt about their ability to achieve this.

Keywords:

• Expectation
• physiotherapy
• chronic pain
• rehabilitation
• qualitative research
• patient perspective
• low back pain

Acknowledgements

The authors wish to thank Hervé Jaccard (PT, MSc) for this contribution to the study preparation.

Ethical approval and study registration

The study received ethical approval (CER-VD protocol 22/14) and was registered (ClinicalTrials.gov Identifier: NCT02123680)

Disclosure statement

The authors report that there are no competing interests to declare.

Additional information

Funding

HES-SO University of Applied Sciences and Arts Western Switzerland Scientific Committee for Health Research. HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.